Provider Demographics
NPI:1194358978
Name:INVICTA THERAPY
Entity Type:Organization
Organization Name:INVICTA THERAPY
Other - Org Name:INVICTA RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TER-GRIGORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-786-4864
Mailing Address - Street 1:2235 LAKE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-6002
Mailing Address - Country:US
Mailing Address - Phone:626-786-4864
Mailing Address - Fax:
Practice Address - Street 1:2235 LAKE AVE STE 110
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-6002
Practice Address - Country:US
Practice Address - Phone:626-786-4864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility