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General NPI Number Information
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NPI Number | 1891074977
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Entity Type | Individual
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Provider Name | MAHTAB MAYA ROUHI
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Gender | Female
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 145 HODENCAMP RD STE 100
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5897
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Country | US
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Telephone | 855-701-7955
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Fax |
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Provider Business Mailing Address
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Address Line | 12821 VICTORY BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3012
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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 |
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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 |
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License Number State |
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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 | 88824
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License Number State | CA
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