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General NPI Number Information
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NPI Number | 1235615543
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Entity Type | Organization
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Legal Business Name | LEILI ZARBAKHSH INTEGRATED INDIVIDUAL AND FAMILY THERAPY PROF. CORP.
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 5005 CANYON CREST DR
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City | RIVERSIDE
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State | CA
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Zip | 92507-7721
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Country | US
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Telephone | 747-447-2090
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Fax | 747-444-4969
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Provider Business Mailing Address
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Address Line | 4642 NOELINE AVE
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City | ENCINO
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State | CA
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Zip | 91436-2104
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Country | US
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Telephone | 310-383-5259
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Fax |
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Authorized Official
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Title or Position | INCORPORATOR
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Name | LEILI ZARBAKHSH
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Credential | LMFT, LEP
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Telephone | 747-447-2090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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