Provider Demographics
NPI:1477679520
Name:SHAKHBANDARYAN, ZHAKLIN (MFT)
Entity Type:Individual
Prefix:MISS
First Name:ZHAKLIN
Middle Name:
Last Name:SHAKHBANDARYAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 N JACKSON ST APT 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3289
Mailing Address - Country:US
Mailing Address - Phone:818-371-5067
Mailing Address - Fax:
Practice Address - Street 1:121 W. LEXINGTON DR.
Practice Address - Street 2:SUITE 808
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203
Practice Address - Country:US
Practice Address - Phone:818-660-5583
Practice Address - Fax:818-545-7613
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF90844106H00000X
225400000X
CAMFT49424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner