Provider Demographics
NPI:1871068866
Name:AVETISYAN, HAYA HAYKUHI (LMFT)
Entity type:Individual
Prefix:
First Name:HAYA
Middle Name:HAYKUHI
Last Name:AVETISYAN
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 1:1218 S GLENDALE AVE # 50
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3205
Mailing Address - Country:US
Mailing Address - Phone:747-208-2623
Mailing Address - Fax:
Practice Address - Street 1:191 S BUENA VISTA ST STE 300
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4556
Practice Address - Country:US
Practice Address - Phone:747-208-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT109455101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7368OtherMEDI-CAL
CA7184OtherMEDI-CAL
CA7708OtherMEDI-CAL
CA7667OtherMEDI-CAL