Healthcare Provider Details

I. General information

NPI: 1972981082
Provider Name (Legal Business Name): MANA EKBATANI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 BUSINESS CENTER DR SUITE # 109
IRVINE CA
92612-1119
US

IV. Provider business mailing address

8 EGRET LN
ALISO VIEJO CA
92656-1759
US

V. Phone/Fax

Practice location:
  • Phone: 949-407-9590
  • Fax:
Mailing address:
  • Phone: 818-430-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: