Provider Demographics
NPI:1992355507
Name:IMANI, MAHDOUNEH (MFTI)
Entity type:Individual
Prefix:
First Name:MAHDOUNEH
Middle Name:
Last Name:IMANI
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2993 N BEVERLY GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1705
Mailing Address - Country:US
Mailing Address - Phone:310-529-5759
Mailing Address - Fax:310-943-2373
Practice Address - Street 1:17514 VENTURA BLVD # 100-101
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3852
Practice Address - Country:US
Practice Address - Phone:310-529-5759
Practice Address - Fax:310-943-2373
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty