Healthcare Provider Details

I. General information

NPI: 1063369304
Provider Name (Legal Business Name): DANIEL KAMYAR SAFAVI LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11620 WILSHIRE BLVD STE 890
LOS ANGELES CA
90025-1793
US

IV. Provider business mailing address

11620 WILSHIRE BLVD STE 890
LOS ANGELES CA
90025-1793
US

V. Phone/Fax

Practice location:
  • Phone: 415-937-7873
  • Fax:
Mailing address:
  • Phone: 415-937-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: