Provider Demographics
NPI:1639471006
Name:KELIGIAN, BRIAN (MFT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:KELIGIAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 LAUREL CANYON BLVD
Mailing Address - Street 2:UNIT 972
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604
Mailing Address - Country:US
Mailing Address - Phone:310-384-8474
Mailing Address - Fax:
Practice Address - Street 1:519 N LA CIENEGA BLVD
Practice Address - Street 2:SUITE 16
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-2007
Practice Address - Country:US
Practice Address - Phone:310-384-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist