Provider Demographics
NPI:1538680731
Name:GHEYTANCHI, ARASH (MFT ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:ARASH
Middle Name:
Last Name:GHEYTANCHI
Suffix:
Gender:M
Credentials:MFT ASSOCIATE
Other - Prefix:MR
Other - First Name:ARASH
Other - Middle Name:
Other - Last Name:GHEYTANCHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:ARASH GHEYTANCHI
Mailing Address - Street 2:5300 ANGELES VISTA BLVD.
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043
Mailing Address - Country:US
Mailing Address - Phone:310-502-5272
Mailing Address - Fax:
Practice Address - Street 1:5300 ANGELES VISTA BLVD
Practice Address - Street 2:
Practice Address - City:VIEW PARK
Practice Address - State:CA
Practice Address - Zip Code:90043
Practice Address - Country:US
Practice Address - Phone:310-502-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA95615106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
95615OtherBBS
CA95615OtherCA BOARD OF BEHAVIORAL SCIENCES