Provider Demographics
NPI:1053964635
Name:HASAN, ALIAH (LMFT 125281)
Entity type:Individual
Prefix:
First Name:ALIAH
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:LMFT 125281
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 W SAN BERNARDINO RD STE 150
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-4156
Mailing Address - Country:US
Mailing Address - Phone:951-902-3212
Mailing Address - Fax:
Practice Address - Street 1:1109 W SAN BERNARDINO RD STE 150
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-4156
Practice Address - Country:US
Practice Address - Phone:951-902-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104952OtherBBS