Provider Demographics
NPI:1891468542
Name:AKOPYAN, ALTAGRACIA D (LMFT 145795)
Entity type:Individual
Prefix:
First Name:ALTAGRACIA
Middle Name:D
Last Name:AKOPYAN
Suffix:
Gender:F
Credentials:LMFT 145795
Other - Prefix:
Other - First Name:ALTAGRACIA
Other - Middle Name:
Other - Last Name:AKOPYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AMFT #125138
Mailing Address - Street 1:1010 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2937
Mailing Address - Country:US
Mailing Address - Phone:818-396-7297
Mailing Address - Fax:
Practice Address - Street 1:1010 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2937
Practice Address - Country:US
Practice Address - Phone:818-396-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125138106H00000X
CA145795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist