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General NPI Number Information
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NPI Number | 1285380212
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Entity Type | Individual
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Provider Name | SOODABEH KHOSROPUR AMFT
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Gender | Female
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 3808 W RIVERSIDE DR
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City | BURBANK
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State | CA
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Zip | 91505-4325
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Country | US
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Telephone | 323-270-7834
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Fax |
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Provider Business Mailing Address
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Address Line | 6526 COSTELLO AVE
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City | VAN NUYS
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State | CA
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Zip | 91401-1505
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Country | US
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Telephone | 323-270-7834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 130170
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License Number State | CA
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