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General NPI Number Information
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NPI Number | 1134658065
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Entity Type | Organization
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Legal Business Name | DR AZADEH GOLSHANI PSYCHOLOGIST PC
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 3415 S SEPULVEDA BLVD STE 1100
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City | LOS ANGELES
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State | CA
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Zip | 90034-7090
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Country | US
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Telephone | 310-927-9853
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Fax |
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Provider Business Mailing Address
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Address Line | 11045 MISSOURI AVE APT 203
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City | LOS ANGELES
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State | CA
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Zip | 90025-5625
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Country | US
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Telephone | 310-927-9853
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | AZADEH GOLSHANI
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Credential | PSY.D
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Telephone | 310-927-9853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | PSY28464
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PSY28464
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | PSY28464
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License Number State | CA
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