Healthcare Provider Details

I. General information

NPI: 1558740225
Provider Name (Legal Business Name): EMOTIONAL FITNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12304 SANTA MONICA BLVD SUITE 315
LOS ANGELES CA
90025
US

IV. Provider business mailing address

12304 SANTA MONICA BLVD SUITE 315
LOS ANGELES CA
90025
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-6626
  • Fax:
Mailing address:
  • Phone: 310-826-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberPSY17001
License Number StateCA

VIII. Authorized Official

Name: MRS. FARIBA RABIZADEH
Title or Position: SECRETARY
Credential: LMFT
Phone: 310-625-2600