Healthcare Provider Details

I. General information

NPI: 1366564932
Provider Name (Legal Business Name): SUFI YOUSEFI-FARKHAN MA MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 E CARSON PLAZA DR SUITE 102
CARSON CA
90746-3228
US

IV. Provider business mailing address

15146 MOORPARK ST # 107
SHERMAN OAKS CA
91403-2422
US

V. Phone/Fax

Practice location:
  • Phone: 310-523-9500
  • Fax: 310-225-2725
Mailing address:
  • Phone: 818-793-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF43889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: