Provider Demographics
NPI:1629102728
Name:TCHAKMAKJIAN, GREG YEGHEYA (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:YEGHEYA
Last Name:TCHAKMAKJIAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 E CHEVY CHASE DR
Mailing Address - Street 2:# 5
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3237
Mailing Address - Country:US
Mailing Address - Phone:818-247-5342
Mailing Address - Fax:
Practice Address - Street 1:6001 CLARA ST
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-4723
Practice Address - Country:US
Practice Address - Phone:562-806-5000
Practice Address - Fax:562-806-9395
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical