Provider Demographics
NPI:1588299614
Name:S T REZAI FAMILY COUNSELING, PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:S T REZAI FAMILY COUNSELING, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SEPIDEH
Authorized Official - Middle Name:TAKMILI
Authorized Official - Last Name:REZAI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-229-1887
Mailing Address - Street 1:5743 CORSA AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6441
Mailing Address - Country:US
Mailing Address - Phone:805-229-1887
Mailing Address - Fax:
Practice Address - Street 1:5743 CORSA AVE STE 112
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6441
Practice Address - Country:US
Practice Address - Phone:805-229-1887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty