Provider Demographics
NPI:1699110239
Name:AZODI-DEYLAMI, SHIFTEH (LMFT)
Entity type:Individual
Prefix:MS
First Name:SHIFTEH
Middle Name:
Last Name:AZODI-DEYLAMI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:SHIFTEH
Other - Middle Name:
Other - Last Name:AZODI-DEYLAMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT147082
Mailing Address - Street 1:34 ERICSON AISLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-5722
Mailing Address - Country:US
Mailing Address - Phone:949-973-6789
Mailing Address - Fax:
Practice Address - Street 1:2035 E BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5159
Practice Address - Country:US
Practice Address - Phone:650-279-6854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147082106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty