Provider Demographics
NPI:1316504871
Name:BHUYAN, MONICA (AMFT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BHUYAN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 FAIR AVE APT 8417
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2779
Mailing Address - Country:US
Mailing Address - Phone:951-204-0506
Mailing Address - Fax:
Practice Address - Street 1:6355 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2102
Practice Address - Country:US
Practice Address - Phone:408-829-5687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113339106H00000X
CA1-21-49142103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA113339OtherASSOCIATE MARRIAGE AND FAMILY THERAPIST