MEDICARE: BAHAREH TALEI PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY21252	CA
2	103TM1800X	Intellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number	:	1083845564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAHAREH TALEI PSY.D.

Provider Business Mailing Address
First Line	:	26500 AGOURA RD
Second Line	:	102-401
City	:	CALABASAS
State	:	CA
Zip	:	91302-1952
Country	:	US
Telephone Number	:	818-307-0741
Fax Number	:	818-394-6409

Provider Business Practice Location Address
First Line	:	30125 AGOURA RD STE 2B
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4345
Country	:	US
Telephone Number	:	818-307-0741
Fax Number	:	818-394-6409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2009
Last Update Date	:	04/19/2023

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