Provider Demographics
NPI:1023398245
Name:GHATAN, BITA (MS)
Entity Type:Individual
Prefix:MS
First Name:BITA
Middle Name:
Last Name:GHATAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5554 RESEDA BLVD.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4162
Mailing Address - Country:US
Mailing Address - Phone:818-705-5522
Mailing Address - Fax:818-705-0522
Practice Address - Street 1:5554 RESEDA BLVD.
Practice Address - Street 2:SUITE 203
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4162
Practice Address - Country:US
Practice Address - Phone:818-705-5522
Practice Address - Fax:818-705-0522
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1234103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst