Healthcare Provider Details

I. General information

NPI: 1053709220
Provider Name (Legal Business Name): MEHRY KHAZAN M.A MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 TWELFTH STREET
MARINA CA
93933
US

IV. Provider business mailing address

299 TWELFTH STREET
MARINA CA
93933
US

V. Phone/Fax

Practice location:
  • Phone: 831-647-7652
  • Fax: 831-647-7940
Mailing address:
  • Phone:
  • 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:
Title or Position:
Credential:
Phone: