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General NPI Number Information
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NPI Number | 1447988514
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Entity Type | Individual
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Provider Name | MRS. TASNEEM KHRAISAT
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Gender | Female
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 12141 BROOKHURST ST STE 101
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City | GARDEN GROVE
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State | CA
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Zip | 92840-2865
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Country | US
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Telephone | 714-296-1934
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Fax |
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Provider Business Mailing Address
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Address Line | 211 S STATE COLLEGE BLVD # 1111
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City | ANAHEIM
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State | CA
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Zip | 92806-4116
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Country | US
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Telephone | 714-900-3442
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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 | 156849
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License Number State | CA
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