Provider Demographics
NPI:1851008189
Name:SHOGHAIR MGRDITCHIAN FAMILY AND INDIVIDUAL THERAPY, INC.
Entity Type:Organization
Organization Name:SHOGHAIR MGRDITCHIAN FAMILY AND INDIVIDUAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHOGHAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MGRDITCHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-644-6632
Mailing Address - Street 1:9558 INSPIRATION WAY
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-3018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3455 OCEAN VIEW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1554
Practice Address - Country:US
Practice Address - Phone:661-524-9932
Practice Address - Fax:661-524-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health