Provider Demographics
NPI:1922582956
Name:BERGHOUDIAN, GARY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:BERGHOUDIAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17541 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1719
Mailing Address - Country:US
Mailing Address - Phone:818-667-3233
Mailing Address - Fax:
Practice Address - Street 1:17514 VENTURA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3852
Practice Address - Country:US
Practice Address - Phone:818-949-8087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health