Provider Demographics
NPI:1679783880
Name:FARAHAN, FATEMEH (MFT)
Entity type:Individual
Prefix:
First Name:FATEMEH
Middle Name:
Last Name:FARAHAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10790 WILSHIRE BLVD
Mailing Address - Street 2:APT. 1002
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4460
Mailing Address - Country:US
Mailing Address - Phone:310-535-1398
Mailing Address - Fax:
Practice Address - Street 1:10350 SANTA MONICA BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5075
Practice Address - Country:US
Practice Address - Phone:310-962-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33640106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist