Provider Demographics
NPI:1063591972
Name:BASSIRI, KAVOOS GHANE (LMFT, LPCC)
Entity type:Individual
Prefix:
First Name:KAVOOS
Middle Name:GHANE
Last Name:BASSIRI
Suffix:
Gender:M
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 JOHN MUIR DR D617
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-6157
Mailing Address - Country:US
Mailing Address - Phone:415-997-9087
Mailing Address - Fax:415-737-0609
Practice Address - Street 1:615 JOHN MUIR DR D617
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-6157
Practice Address - Country:US
Practice Address - Phone:415-997-9087
Practice Address - Fax:415-737-0609
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA852101YP2500X
OHE.1901525101YP2500X
OHF.1900098106H00000X
CA32987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional