Provider Demographics
NPI:1609908730
Name:KOHANBASH, BETHIE KOHANCHI (LMFT)
Entity type:Individual
Prefix:MRS
First Name:BETHIE
Middle Name:KOHANCHI
Last Name:KOHANBASH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 S DURANGO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3328
Mailing Address - Country:US
Mailing Address - Phone:310-968-6648
Mailing Address - Fax:
Practice Address - Street 1:1462 S DURANGO AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3328
Practice Address - Country:US
Practice Address - Phone:310-968-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist