Healthcare Provider Details

I. General information

NPI: 1972241610
Provider Name (Legal Business Name): MICHAEL AZAD MORADIAN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8055 CANBY AVE UNIT 4
RESEDA CA
91335-1384
US

IV. Provider business mailing address

8055 CANBY AVE UNIT 4
RESEDA CA
91335-1384
US

V. Phone/Fax

Practice location:
  • Phone: 818-434-9692
  • Fax: 818-700-0933
Mailing address:
  • Phone: 818-434-9692
  • Fax: 818-700-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number132857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: