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General NPI Number Information
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NPI Number | 1396577615
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Entity Type | Individual
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Provider Name | HEBATALLA KAMAL GHONEIM AMFT
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Gender | Female
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Dates
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Enumeration Date | 08/15/2024
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Last Update Date | 08/17/2024
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Provider Practice Location Address
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Address Line | 1849 SAWTELLE BLVD STE 610
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City | LOS ANGELES
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State | CA
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Zip | 90025-7013
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Country | US
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Telephone | 424-361-9895
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Fax |
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Provider Business Mailing Address
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Address Line | 7436 MIRAMONTE
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City | IRVINE
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State | CA
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Zip | 92618-4841
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Country | US
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Telephone | 949-981-4455
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9909
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 126710
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License Number State | CA
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