Provider Demographics
NPI:1891967394
Name:BAGATOURIAN, DIANE (LMFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BAGATOURIAN
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 1:46E PENINSULA CTR # 141
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3506
Mailing Address - Country:US
Mailing Address - Phone:310-344-1550
Mailing Address - Fax:310-715-1295
Practice Address - Street 1:5762 RAVENSPUR DR
Practice Address - Street 2:#414
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-3570
Practice Address - Country:US
Practice Address - Phone:310-344-1550
Practice Address - Fax:310-715-1295
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA91229106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program