Healthcare Provider Details

I. General information

NPI: 1699694489
Provider Name (Legal Business Name): MORIDI FAMILY COUNSELING AND PSYCHOTHERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11344 COLOMA RD STE 660
GOLD RIVER CA
95670-4464
US

IV. Provider business mailing address

11344 COLOMA RD STE 660
GOLD RIVER CA
95670-4464
US

V. Phone/Fax

Practice location:
  • Phone: 916-251-9379
  • Fax:
Mailing address:
  • Phone: 916-251-9379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: IMAN MORIDI
Title or Position: OWNER/CEO
Credential: LMFT
Phone: 916-251-9379