Provider Demographics
NPI:1417586942
Name:GHAYOUMI, TALA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TALA
Middle Name:
Last Name:GHAYOUMI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 LAUREL CANYON BLVD UNIT 306
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2256
Mailing Address - Country:US
Mailing Address - Phone:818-523-7157
Mailing Address - Fax:
Practice Address - Street 1:4240 LAUREL CANYON BLVD UNIT 306
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2256
Practice Address - Country:US
Practice Address - Phone:818-523-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33240103TC0700X, 103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program