Healthcare Provider Details

I. General information

NPI: 1154244382
Provider Name (Legal Business Name): HASTISADAT MORADI M.A., AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HASTISADAT MOJAHED GOMNAM

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18008 SKY PARK CIR STE 140
IRVINE CA
92614-6434
US

IV. Provider business mailing address

8583 IRVINE CENTER DR # 275
IRVINE CA
92618-4298
US

V. Phone/Fax

Practice location:
  • Phone: 949-342-5517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20229
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: