Provider Demographics
NPI:1225574635
Name:MINELIAN, ELIZABETH KOHAR (MA, MFT, CADC II)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KOHAR
Last Name:MINELIAN
Suffix:
Gender:F
Credentials:MA, MFT, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 12TH STREET UNIT A
Mailing Address - Street 2:
Mailing Address - City:SANTA MONINCA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-261-8016
Mailing Address - Fax:310-823-1506
Practice Address - Street 1:1813 12TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4637
Practice Address - Country:US
Practice Address - Phone:310-261-8016
Practice Address - Fax:310-823-1506
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA011120315101YA0400X
CAIMF73056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist