Provider Demographics
NPI:1316571987
Name:KEYNAN, NITZAN (LMFT)
Entity Type:Individual
Prefix:
First Name:NITZAN
Middle Name:
Last Name:KEYNAN
Suffix:
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 1:636 S BURNSIDE AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3982
Mailing Address - Country:US
Mailing Address - Phone:310-430-3046
Mailing Address - Fax:
Practice Address - Street 1:636 S BURNSIDE AVE APT 307
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3982
Practice Address - Country:US
Practice Address - Phone:310-430-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT99849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist