Provider Demographics
NPI:1750716270
Name:TAKHMAZYAN, HERBERT (LMFT)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:TAKHMAZYAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:GERBERD
Other - Middle Name:
Other - Last Name:TAKHMAZYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91043-0289
Mailing Address - Country:US
Mailing Address - Phone:818-497-2813
Mailing Address - Fax:
Practice Address - Street 1:2331 HONOLULU AVE STE H
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1844
Practice Address - Country:US
Practice Address - Phone:424-250-0643
Practice Address - Fax:424-281-0561
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT95723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist