Provider Demographics
NPI:1578694410
Name:GHOSE, MOUSHUMI G (MFT)
Entity Type:Individual
Prefix:MS
First Name:MOUSHUMI
Middle Name:G
Last Name:GHOSE
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 1:1625 N SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-3745
Mailing Address - Country:US
Mailing Address - Phone:323-739-4250
Mailing Address - Fax:818-936-0593
Practice Address - Street 1:201 N BRAND BLVD UNIT 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3590
Practice Address - Country:US
Practice Address - Phone:323-397-4250
Practice Address - Fax:818-936-0593
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44134106H00000X
CAMFC44134106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist