Provider Demographics
NPI:1639742620
Name:GALSTYAN, HENRIETA (LMFT)
Entity Type:Individual
Prefix:
First Name:HENRIETA
Middle Name:
Last Name:GALSTYAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 S GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4925
Mailing Address - Country:US
Mailing Address - Phone:818-441-9664
Mailing Address - Fax:
Practice Address - Street 1:10722 WHITE OAK AVE STE 5
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4652
Practice Address - Country:US
Practice Address - Phone:818-441-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist