Provider Demographics
NPI:1528858354
Name:KHODDAMI, MANYA (PSYD & LMFT)
Entity type:Individual
Prefix:DR
First Name:MANYA
Middle Name:
Last Name:KHODDAMI
Suffix:
Gender:F
Credentials:PSYD & LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25511 COLETTE WAY
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3151
Mailing Address - Country:US
Mailing Address - Phone:818-614-4409
Mailing Address - Fax:
Practice Address - Street 1:25511 COLETTE WAY
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3151
Practice Address - Country:US
Practice Address - Phone:818-614-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT97662106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist