Provider Demographics
NPI:1689248163
Name:BAGHOUMIAN, EMANOUEL
Entity Type:Individual
Prefix:
First Name:EMANOUEL
Middle Name:
Last Name:BAGHOUMIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 W VERDUGO AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2879
Mailing Address - Country:US
Mailing Address - Phone:818-635-2559
Mailing Address - Fax:
Practice Address - Street 1:274 W VERDUGO AVE APT 307
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2879
Practice Address - Country:US
Practice Address - Phone:818-635-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor