Basic Information
| Provider Information | |||||||||
| NPI: | 1235887191 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARDANYAN | ||||||||
| FirstName: | TIGRAN | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 849 E 6TH ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900211026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136238446 | ||||||||
| FaxNumber: | 2138961880 | ||||||||
| Practice Location | |||||||||
| Address1: | 849 E 6TH ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900211026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136238446 | ||||||||
| FaxNumber: | 2138961880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2022 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 128889 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.