Provider Demographics
NPI:1750410858
Name:IVANOVA, TEMENUGA GEORGIEVA (MFT)
Entity type:Individual
Prefix:DR
First Name:TEMENUGA
Middle Name:GEORGIEVA
Last Name:IVANOVA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:DR
Other - First Name:TEMENUGA
Other - Middle Name:GEORGIEVA
Other - Last Name:IVANOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:123 N HAYWORTH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3635
Mailing Address - Country:US
Mailing Address - Phone:323-281-1921
Mailing Address - Fax:
Practice Address - Street 1:123 N HAYWORTH AVE
Practice Address - Street 2:#8
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3635
Practice Address - Country:US
Practice Address - Phone:323-281-1921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 39120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist