Healthcare Provider Details

I. General information

NPI: 1407409097
Provider Name (Legal Business Name): GOZDE GOKOZAN, LMFT, LPCC, MARRIAGE, FAMILY AND CHILD PROFESSIONAL COU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 BRIGHTON WAY STE 219
BEVERLY HILLS CA
90210-5118
US

IV. Provider business mailing address

9615 BRIGHTON WAY STE 219
BEVERLY HILLS CA
90210-5118
US

V. Phone/Fax

Practice location:
  • Phone: 424-333-0288
  • Fax:
Mailing address:
  • Phone: 424-333-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: GOZDE GOKOZAN
Title or Position: OWNER
Credential: LMFT, LPCC
Phone: 424-333-0288