Provider Demographics
NPI:1679067193
Name:GORJIAN, MEGHRIK YENOKI
Entity Type:Individual
Prefix:
First Name:MEGHRIK
Middle Name:YENOKI
Last Name:GORJIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGHRIK
Other - Middle Name:
Other - Last Name:YENOKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEGHRIK YOUNKI
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91043-0833
Mailing Address - Country:US
Mailing Address - Phone:818-569-9632
Mailing Address - Fax:
Practice Address - Street 1:237 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3526
Practice Address - Country:US
Practice Address - Phone:818-569-9632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAASW101855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99512149EMedicaid
CA906597464Medicaid