Provider Demographics
NPI:1154517431
Name:AMIRI, SOUSAN (MS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:SOUSAN
Middle Name:
Last Name:AMIRI
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 YORK PL
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2441
Mailing Address - Country:US
Mailing Address - Phone:805-497-8030
Mailing Address - Fax:
Practice Address - Street 1:5655 LINDERO CANYON RD STE 405
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4046
Practice Address - Country:US
Practice Address - Phone:805-231-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAMFC 48439106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist