=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093560476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE HEALTHY MIND PSYCHOLOGY SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2024
-----------------------------------------------------
Last Update Date | 04/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31142 VIA COLINAS
-----------------------------------------------------
City | COTO DE CAZA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92679-4005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-280-5544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18375 VENTURA BLVD STE 646
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-4218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-280-5544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. SADAF NEZHAD
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 714-280-5544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------