Healthcare Provider Details

I. General information

NPI: 1477101285
Provider Name (Legal Business Name): FATIMA TABASUM SYED AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15111 WHITTIER BLVD STE 250
WHITTIER CA
90603-3307
US

IV. Provider business mailing address

15111 WHITTIER BLVD STE 250
WHITTIER CA
90603-3307
US

V. Phone/Fax

Practice location:
  • Phone: 323-461-3161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT146420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: