Provider Demographics
NPI:1114557485
Name:ALBANO, KHATYA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:KHATYA
Middle Name:
Last Name:ALBANO
Suffix:
Gender:F
Credentials:MA, 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 20562
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-3562
Mailing Address - Country:US
Mailing Address - Phone:562-999-1449
Mailing Address - Fax:
Practice Address - Street 1:3620 LONG BEACH BLVD.
Practice Address - Street 2:SUITE C9
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-6012
Practice Address - Country:US
Practice Address - Phone:562-999-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114506106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist