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16800 Devonshire St Ste 201 Granada Hills CA 91344-7409 | |
| (818) 309-7440 | |
| (818) 217-4699 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 16800 Devonshire St Ste 201, Granada Hills, California |
| Authorized Official Name and Position | Evelina Krpekyan (CEO) |
| Authorized Official Contact | 8183097440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
18651 Nau Ave Porter Ranch CA 91326-2111 Ph: (818) 309-7440 | 16800 Devonshire St Ste 201 Granada Hills CA 91344-7409 Ph: (818) 309-7440 |
| NPI Number | 1255033569 |
|---|---|
| Provider Enumeration Date | 03/20/2023 |
| Last Update Date | 09/11/2024 |
| Certification Date | 09/11/2024 |
| Medicare PECOS PAC ID | 6204377237 |
|---|---|
| Medicare Enrollment ID | O20240918001496 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255033569 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Evelina Krpekyan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326199563 PECOS PAC ID: 1658812680 Enrollment ID: I20240918001585 |
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