Provider Demographics
NPI:1225744923
Name:KIRAKOSYAN, ANI I (LMFT)
Entity Type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:KIRAKOSYAN
Suffix:I
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 1:225 E BROADWAY STE 301A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1008
Mailing Address - Country:US
Mailing Address - Phone:818-612-5588
Mailing Address - Fax:
Practice Address - Street 1:225 E BROADWAY STE 301A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1008
Practice Address - Country:US
Practice Address - Phone:818-612-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100264106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty