Healthcare Provider Details

I. General information

NPI: 1881840510
Provider Name (Legal Business Name): FARIBA GHORBANI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 FAIRVIEW AVE E SUITE 200
SEATTLE WA
98102
US

IV. Provider business mailing address

19307 65TH AVE NE
KENMORE WA
98028
US

V. Phone/Fax

Practice location:
  • Phone: 206-781-6696
  • Fax:
Mailing address:
  • Phone: 206-781-6696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLH00007523
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: