Provider Demographics
NPI:1912606302
Name:MSITUA THERAPY INC.
Entity Type:Organization
Organization Name:MSITUA THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKOPYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-939-2471
Mailing Address - Street 1:1523 E WINDSOR RD APT 105C
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2751
Mailing Address - Country:US
Mailing Address - Phone:818-939-2471
Mailing Address - Fax:
Practice Address - Street 1:1523 E WINDSOR RD APT 105C
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2751
Practice Address - Country:US
Practice Address - Phone:818-939-2471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-16-21370OtherBEHAVIORAL HEALTH ABA