Provider Demographics
NPI:1144509332
Name:KESHISHIAN, NAREK (MA)
Entity type:Individual
Prefix:
First Name:NAREK
Middle Name:
Last Name:KESHISHIAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 CORDERO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:91042
Mailing Address - Country:US
Mailing Address - Phone:818-405-3739
Mailing Address - Fax:
Practice Address - Street 1:1540 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1514
Practice Address - Country:US
Practice Address - Phone:818-244-7257
Practice Address - Fax:818-243-5431
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86501106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist