| Advanced Mental Health Center, Inc. | |
|
17514 Ventura Blvd 100 Encino CA 91316-3852 | |
| (310) 877-0600 | |
| Not Available |
| Full Name | Advanced Mental Health Center, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 17514 Ventura Blvd, Encino, California |
| Authorized Official Name and Position | Farzaneh Ehsan (PSYCHOLOGIST) |
| Authorized Official Contact | 3108770600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Mental Health Center, Inc. 18740 Ventura Blvd Ste 202 Tarzana CA 91356-6310 Ph: (310) 877-0600 | Advanced Mental Health Center, Inc. 17514 Ventura Blvd 100 Encino CA 91316-3852 Ph: (310) 877-0600 |
| NPI Number | 1881140929 |
|---|---|
| Provider Enumeration Date | 08/29/2016 |
| Last Update Date | 05/04/2020 |
| Certification Date | 05/04/2020 |
| Medicare PECOS PAC ID | 3971883604 |
|---|---|
| Medicare Enrollment ID | O20161214002245 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881140929 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY28121 (California) | Primary |
| Provider Name | Farzaneh Ehsan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144647819 PECOS PAC ID: 9537339478 Enrollment ID: I20160617001299 |
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