Provider Demographics
NPI:1306317102
Name:MOHEBBI, GOLNAZ
Entity type:Individual
Prefix:
First Name:GOLNAZ
Middle Name:
Last Name:MOHEBBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22817 VENTURA BLVD # 401
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1202
Mailing Address - Country:US
Mailing Address - Phone:310-210-5925
Mailing Address - Fax:
Practice Address - Street 1:11631 VICTORY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3572
Practice Address - Country:US
Practice Address - Phone:818-908-3855
Practice Address - Fax:818-753-5265
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CA76571106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health