Provider Demographics
NPI:1396202206
Name:MERIDIAN COUNSELING
Entity Type:Organization
Organization Name:MERIDIAN COUNSELING
Other - Org Name:MERIDIAN COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNIR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-428-7240
Mailing Address - Street 1:11640 GORHAM AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4727
Mailing Address - Country:US
Mailing Address - Phone:310-428-7240
Mailing Address - Fax:
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 815E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5056
Practice Address - Country:US
Practice Address - Phone:323-332-9905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780065045OtherNPI 1