Provider Demographics
NPI:1437626488
Name:THE KHACHATRYAN CORPORATION, LICENSED PROFESSIONAL CLINICAL COUNSELOR
Entity Type:Organization
Organization Name:THE KHACHATRYAN CORPORATION, LICENSED PROFESSIONAL CLINICAL COUNSELOR
Other - Org Name:HEALTHY MINDS COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TATEVIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KHACHATRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:619-206-5271
Mailing Address - Street 1:591 CAMINO DE LA REINA STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3104
Mailing Address - Country:US
Mailing Address - Phone:619-206-5271
Mailing Address - Fax:619-795-3274
Practice Address - Street 1:591 CAMINO DE LA REINA STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3104
Practice Address - Country:US
Practice Address - Phone:619-206-5271
Practice Address - Fax:619-795-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty