Healthcare Provider Details

I. General information

NPI: 1164382719
Provider Name (Legal Business Name): SEPIDEH MOKHTARZADEH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S ELM DR APT 101
BEVERLY HILLS CA
90212-4623
US

IV. Provider business mailing address

340 S ELM DR APT 101
BEVERLY HILLS CA
90212-4623
US

V. Phone/Fax

Practice location:
  • Phone: 213-880-8017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: