Provider Demographics
NPI:1366564932
Name:YOUSEFI-FARKHAN, SUFI (MA MFTI)
Entity type:Individual
Prefix:MRS
First Name:SUFI
Middle Name:
Last Name:YOUSEFI-FARKHAN
Suffix:
Gender:F
Credentials:MA MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15146 MOORPARK ST # 107
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2422
Mailing Address - Country:US
Mailing Address - Phone:818-793-7073
Mailing Address - Fax:
Practice Address - Street 1:460 E CARSON PLAZA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3228
Practice Address - Country:US
Practice Address - Phone:310-523-9500
Practice Address - Fax:310-225-2725
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF43889106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007570Medicaid
CACBSC403OtherLA DMH PROVIDER