Provider Demographics
NPI:1053697904
Name:TASHJIAN, WAYNE (MFT, BCBA)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:TASHJIAN
Suffix:
Gender:M
Credentials:MFT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 VENTURA BLVD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2914
Mailing Address - Country:US
Mailing Address - Phone:818-728-9370
Mailing Address - Fax:818-788-3875
Practice Address - Street 1:15720 VENTURA BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2914
Practice Address - Country:US
Practice Address - Phone:818-728-9370
Practice Address - Fax:818-788-3875
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA# 1-10-7653103K00000X
CAMFC30490106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst