Provider Demographics
NPI:1306047089
Name:KAZEMI, MASSOUMEH S (LPC, LISAC)
Entity type:Individual
Prefix:MS
First Name:MASSOUMEH
Middle Name:S
Last Name:KAZEMI
Suffix:
Gender:F
Credentials:LPC, LISAC
Other - Prefix:MS
Other - First Name:HELEN
Other - Middle Name:S
Other - Last Name:KAZEMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LISAC
Mailing Address - Street 1:6404 E BAR Z LN
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1819
Mailing Address - Country:US
Mailing Address - Phone:480-390-0998
Mailing Address - Fax:
Practice Address - Street 1:4222 E CAMELBACK RD
Practice Address - Street 2:SUITE H210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2745
Practice Address - Country:US
Practice Address - Phone:480-390-0998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10839101YA0400X
AZLPC-12214101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional