=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275352635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ITS A PROCESS THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2024
-----------------------------------------------------
Last Update Date | 10/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1860 9TH ST APT 14
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-4584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-338-5097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3024
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90408-3024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-338-5097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/FOUNDER
-----------------------------------------------------
Name | SHABNAM HAFIZI
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 805-338-5097
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------