Provider Demographics
NPI:1245470384
Name:WOSOUGHIAN, EDNA R
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:R
Last Name:WOSOUGHIAN
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 1:2746 CONEJO CANYON CT
Mailing Address - Street 2:#21
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5713
Mailing Address - Country:US
Mailing Address - Phone:818-442-8536
Mailing Address - Fax:
Practice Address - Street 1:2746 CONEJO CANYON CT
Practice Address - Street 2:#21
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-5713
Practice Address - Country:US
Practice Address - Phone:818-442-8536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health