Healthcare Provider Details

I. General information

NPI: 1184558181
Provider Name (Legal Business Name): ATEFEH REZAEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5349 NEWCASTLE AVE APT 21
ENCINO CA
91316-3041
US

IV. Provider business mailing address

5349 NEWCASTLE AVE APT 21
ENCINO CA
91316-3041
US

V. Phone/Fax

Practice location:
  • Phone: 818-470-0041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC22615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: