Provider Demographics
NPI:1528372125
Name:MEDICAL AND BEHAVIORAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:MEDICAL AND BEHAVIORAL HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASTRIK
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:818-240-0108
Mailing Address - Street 1:222 WEST EULALIA ST.
Mailing Address - Street 2:SUITE # 301
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204
Mailing Address - Country:US
Mailing Address - Phone:818-240-0108
Mailing Address - Fax:818-240-0301
Practice Address - Street 1:222 W EULALIA ST STE 301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2851
Practice Address - Country:US
Practice Address - Phone:818-240-0108
Practice Address - Fax:818-240-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21838103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty