Provider Demographics
NPI:1053812420
Name:TAGHEHCHIAN, ROYA (ASSOCIATE MFT)
Entity type:Individual
Prefix:
First Name:ROYA
Middle Name:
Last Name:TAGHEHCHIAN
Suffix:
Gender:F
Credentials:ASSOCIATE MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 PINE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3633
Mailing Address - Country:US
Mailing Address - Phone:925-984-7215
Mailing Address - Fax:
Practice Address - Street 1:1250 PINE ST STE 101
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3633
Practice Address - Country:US
Practice Address - Phone:925-984-7215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherMARRIAGE AND FAMILY THERAPIST