Provider Demographics
NPI:1295201267
Name:AVEDIAN MARRIAGE AND FAMILY THERAPY CORPORATION
Entity Type:Organization
Organization Name:AVEDIAN MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVEDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:818-426-2495
Mailing Address - Street 1:15233 VENTURA BLVD STE 1208
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2271
Mailing Address - Country:US
Mailing Address - Phone:818-426-2495
Mailing Address - Fax:818-783-2927
Practice Address - Street 1:15233 VENTURA BLVD STE 1208
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2271
Practice Address - Country:US
Practice Address - Phone:818-426-2495
Practice Address - Fax:818-783-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty