Provider Demographics
NPI:1689453268
Name:MINASSIAN, EDIT TINA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:EDIT
Middle Name:TINA
Last Name:MINASSIAN
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 1:11053 HILLHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-1419
Mailing Address - Country:US
Mailing Address - Phone:818-968-0577
Mailing Address - Fax:
Practice Address - Street 1:11053 HILLHAVEN AVE
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-1419
Practice Address - Country:US
Practice Address - Phone:818-968-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist