Provider Demographics
NPI:1912591983
Name:GRIGORYAN, LIANA (AMFT)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:GRIGORYAN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25050 AVENUE KEARNY STE 203
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1257
Mailing Address - Country:US
Mailing Address - Phone:818-424-9616
Mailing Address - Fax:
Practice Address - Street 1:25050 AVENUE KEARNY STE 203
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1257
Practice Address - Country:US
Practice Address - Phone:818-424-9616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT104140101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health