Basic Information
| Provider Information | |||||||||
| NPI: | 1437626488 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE KHACHATRYAN CORPORATION, LICENSED PROFESSIONAL CLINICAL COUNSELOR | ||||||||
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| OtherOrganizationName: | HEALTHY MINDS COUNSELING SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 591 CAMINO DE LA REINA STE 210 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192065271 | ||||||||
| FaxNumber: | 6197953274 | ||||||||
| Practice Location | |||||||||
| Address1: | 591 CAMINO DE LA REINA STE 210 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192065271 | ||||||||
| FaxNumber: | 6197953274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2018 | ||||||||
| LastUpdateDate: | 05/31/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KHACHATRYAN | ||||||||
| AuthorizedOfficialFirstName: | TATEVIK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 6192065271 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA | ||||||||
| NPICertificationDate: | 05/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 101Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.