Healthcare Provider Details

I. General information

NPI: 1134729858
Provider Name (Legal Business Name): ALLE HERZ PSYCHOTHERAPY, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 09/23/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 W LAMBERT RD STE 212
BREA CA
92821-3920
US

IV. Provider business mailing address

1407 PONDEROSA AVE
FULLERTON CA
92835-2036
US

V. Phone/Fax

Practice location:
  • Phone: 949-293-6249
  • Fax:
Mailing address:
  • Phone: 949-293-6249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. YASAMIN FARHAD
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT, PHD
Phone: 949-293-6249