Provider Demographics
NPI:1841643392
Name:MANOUGUIAN, ALINE
Entity type:Individual
Prefix:
First Name:ALINE
Middle Name:
Last Name:MANOUGUIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALINE
Other - Middle Name:
Other - Last Name:MANOUGUIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:2275 HUNTINGTON DR
Mailing Address - Street 2:424
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2640
Mailing Address - Country:US
Mailing Address - Phone:818-414-3290
Mailing Address - Fax:
Practice Address - Street 1:11650 RIVERSIDE DR
Practice Address - Street 2:10
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1093
Practice Address - Country:US
Practice Address - Phone:818-224-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41909106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist