Provider Demographics
NPI:1710341037
Name:JANKLY, AIBINA GHADIMIAN
Entity Type:Individual
Prefix:
First Name:AIBINA
Middle Name:GHADIMIAN
Last Name:JANKLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N MARYLAND AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4281
Mailing Address - Country:US
Mailing Address - Phone:818-330-5015
Mailing Address - Fax:
Practice Address - Street 1:230 N MARYLAND AVE STE 303
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4281
Practice Address - Country:US
Practice Address - Phone:818-330-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF91771106H00000X
CALMFT111464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist