Provider Demographics
NPI:1538680731
Name:GHEYTANCHI, ARASH (MFT ASSOCIATE)
Entity type:Individual
Prefix:MR
First Name:ARASH
Middle Name:
Last Name:GHEYTANCHI
Suffix:
Gender:M
Credentials:MFT ASSOCIATE
Other - Prefix:MR
Other - First Name:ARASH
Other - Middle Name:
Other - Last Name:GHEYTANCHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:560 S ST LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-4320
Mailing Address - Country:US
Mailing Address - Phone:213-480-1557
Mailing Address - Fax:
Practice Address - Street 1:560 S ST LOUIS ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4320
Practice Address - Country:US
Practice Address - Phone:213-480-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWAIVER103TC0700X
CA95615106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
95615OtherBBS
CA95615OtherCA BOARD OF BEHAVIORAL SCIENCES