Advanced Mental Health Center, Inc.
Organization Active NPI Clinical Psychologist · Encino, CA
NPI 1881140929 · NPPES record last updated May 4, 2020
Key facts
- NPI
- 1881140929
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY28121 (CA)
- Legal business name
- ADVANCED MENTAL HEALTH CENTER, INC.
- Practice address
- 17514 Ventura Blvd
100
Encino, CA 91316-3852 - Phone
- (310) 877-0600
- NPI assigned
- Aug 29, 2016
- Organization subpart
- No
Authorized official
- Name
- Dr. Farzaneh Ehsan, PSY,D.
- Title
- Psychologist
- Phone
- (310) 877-0600
Practitioners 5
-
Farzaneh Ehsan, PSYD
-
Debi Ash, LMFT
-
Mojdeh Yahyaabadi Hormozian, PSYCHOLOGIST
-
Robert Eugene Leeburg, LCSW
-
Eva Sahar Mohebban, ASW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161214002245 | CA | Part B Supplier - Clinic/Group Practice | 3971883604 |
Receives reassigned benefits from 1 practitioner Practice locations: Sherman Oaks, CA |
National Provider Directory
Locations
17514 Ventura Blvd
Ste 100
Encino, CA 91316
Phone (310) 877-0600
17514 Ventura Blvd
#100
Encino, CA 91316
Phone (310) 877-0600
15315 Magnolia Blvd
Ste 400
Sherman Oaks, CA 91403
Phone (310) 877-0600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | PSY28121 | CA | Yes |
Addresses
Primary practice location
17514 Ventura Blvd
100
Encino, CA 91316-3852
Mailing address
18740 Ventura Blvd Ste 202
Tarzana, CA 91356-6310
Phone (310) 877-0600
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All providers in Encino, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.