Provider Demographics
NPI:1265584031
Name:AVIAD, BETTY (MFT)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:
Last Name:AVIAD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 BALBOA BLVD
Mailing Address - Street 2:#104
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-907-7455
Mailing Address - Fax:818-789-7145
Practice Address - Street 1:5435 BALBOA BLVD
Practice Address - Street 2:#104
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-907-7455
Practice Address - Fax:818-789-7145
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 19905106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist