Provider Demographics
NPI:1538466800
Name:GHEYTANCHI, ANAHITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANAHITA
Middle Name:
Last Name:GHEYTANCHI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 WESTWOOD BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6342
Mailing Address - Country:US
Mailing Address - Phone:310-709-3073
Mailing Address - Fax:
Practice Address - Street 1:2035 WESTWOOD BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6332
Practice Address - Country:US
Practice Address - Phone:323-270-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25467103TC0700X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging