Provider Demographics
NPI:1518666361
Name:FULL HOUSE THERAPY, INC.
Entity Type:Organization
Organization Name:FULL HOUSE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARAL
Authorized Official - Middle Name:
Authorized Official - Last Name:YERETSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-939-2471
Mailing Address - Street 1:7828 BELLAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2116
Mailing Address - Country:US
Mailing Address - Phone:818-939-2471
Mailing Address - Fax:
Practice Address - Street 1:7828 BELLAIRE AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-2116
Practice Address - Country:US
Practice Address - Phone:818-939-2471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11212270OtherBEHAVIORAL HEALTH