Provider Demographics
NPI:1578734125
Name:SELIKTAR, MIKE AZARYA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:AZARYA
Last Name:SELIKTAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7250 FRANKLIN AVE. # 810
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:323-851-7723
Mailing Address - Fax:
Practice Address - Street 1:4929 WILSHIRE BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3808
Practice Address - Country:US
Practice Address - Phone:562-904-3999
Practice Address - Fax:855-688-6746
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist