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General NPI Number Information
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NPI Number | 1245872571
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Entity Type | Organization
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Legal Business Name | HEAL AND THRIVE PSYCHOTHERAPY
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 14241 FIRESTONE BLVD STE 400
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City | LA MIRADA
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State | CA
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Zip | 90638-5534
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Country | US
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Telephone | 818-606-1357
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Fax | 714-820-6794
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Provider Business Mailing Address
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Address Line | 14241 FIRESTONE BLVD STE 400
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City | LA MIRADA
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State | CA
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Zip | 90638-5534
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Country | US
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Telephone | 818-606-1357
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Fax | 714-820-6794
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Authorized Official
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Title or Position | COO
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Name | MR. ROOZBEH KHOSHNIYAT
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Credential |
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Telephone | 818-606-1357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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