Provider Demographics
NPI:1104302678
Name:ESHTEHARDI, SIMIN (LMFT)
Entity type:Individual
Prefix:MISS
First Name:SIMIN
Middle Name:
Last Name:ESHTEHARDI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:SIMINA
Other - Middle Name:
Other - Last Name:ESHTEHARDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90637-0642
Mailing Address - Country:US
Mailing Address - Phone:949-444-9931
Mailing Address - Fax:
Practice Address - Street 1:2115 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2203
Practice Address - Country:US
Practice Address - Phone:323-938-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107463106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist