Healthcare Provider Details

I. General information

NPI: 1598851909
Provider Name (Legal Business Name): MINOO SAEEDVAFA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 WILBUR AVE. #302
TARZANA CA
91356
US

IV. Provider business mailing address

520 S. SEPULVEDA #402
LOS ANGELES CA
90049
US

V. Phone/Fax

Practice location:
  • Phone: 310-339-7667
  • Fax:
Mailing address:
  • Phone: 310-339-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC37208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: