Provider Demographics
NPI:1427647890
Name:RAZI, MELODY BAHAREH (AMFT)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:BAHAREH
Last Name:RAZI
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8739 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4507
Mailing Address - Country:US
Mailing Address - Phone:310-623-1477
Mailing Address - Fax:310-854-0134
Practice Address - Street 1:8739 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4507
Practice Address - Country:US
Practice Address - Phone:310-623-1477
Practice Address - Fax:310-854-0134
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2024-09-30
Deactivation Date:2024-07-23
Deactivation Code:
Reactivation Date:2024-07-31
Provider Licenses
StateLicense IDTaxonomies
CA148088106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist