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General NPI Number Information
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NPI Number | 1245967207
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Entity Type | Organization
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Legal Business Name | MARYAM KHODAEIKALAKI PROFESSIONAL CLINICAL COUNSELOR PC
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Dates
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Enumeration Date | 08/01/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 26317 W BRAVO LN
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City | CALABASAS
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State | CA
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Zip | 91302-1082
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Country | US
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Telephone | 310-279-7860
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Fax |
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Provider Business Mailing Address
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Address Line | 26317 W BRAVO LN
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City | CALABASAS
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State | CA
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Zip | 91302-1082
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARYAM KHODAEIKALAKI
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Credential | LPCC
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Telephone | 310-279-7860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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