Individual provider Active NPI

Shoghair Christine Mgrditchian

  • Marriage & Family Therapist
  • Glendale, CA
National Provider Identifier
1063557767
Registry record updated Aug 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
104857 Issued in CA
Practice address
1540 E Colorado St
Glendale, CA 91205
Phone
(818) 244-7257
Fax
(818) 243-5431
NPI assigned
Feb 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 104857 CA Primary

Addresses

Primary practice location

1540 E Colorado St
Glendale, CA 91205

Mailing address

4760 Sepulveda Blvd
Culver City, CA 90230-4820
Phone (310) 390-6612

Other practice location 1

237 N. Central Ave. #C
Glendale, CA 91203
Phone (818) 547-9544

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240830002977 CA Practitioner - Marriage and Family Therapist 0547709776 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2505 Foothill Blvd
Suite D
La Crescenta, CA 91214-4555
Phone (661) 524-9932

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
104857CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Shoghair Mgrditchian Family and Individual Therapy Inc Marriage & Family Therapist CurrentSince Jul 16, 2024 Accepting new patients

Locations

2505 Foothill Blvd
Ste D
La Crescenta, CA 91214
Phone (661) 524-9932

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533081600000",
    "number": "1063557767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4760 SEPULVEDA BLVD",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902304820",
            "telephone_number": "310-390-6612",
            "fax_number": "310-398-5690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 E COLORADO ST",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91205",
            "telephone_number": "818-244-7257",
            "fax_number": "818-243-5431"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "237 N. Central Ave. #C",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "CA",
            "postal_code": "91203",
            "country_code": "US",
            "telephone_number": "818-547-9544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MGRDITCHIAN",
        "first_name": "SHOGHAIR",
        "middle_name": "CHRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-20",
        "last_updated": "2018-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "104857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.