Provider Demographics
NPI:1033681903
Name:KHOUDIKIAN, LORY (LMFT)
Entity Type:Individual
Prefix:
First Name:LORY
Middle Name:
Last Name:KHOUDIKIAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91012-0287
Mailing Address - Country:US
Mailing Address - Phone:818-945-0835
Mailing Address - Fax:
Practice Address - Street 1:1010 N CENTRAL AVE # 311
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2937
Practice Address - Country:US
Practice Address - Phone:818-945-0835
Practice Address - Fax:818-484-2991
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5859101YP2500X
CA136418106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional