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NPI Code Detail

MEDICARE: S T REZAI FAMILY COUNSELING, PROFESSIONAL CORPORATION

MEDICARE: S T REZAI FAMILY COUNSELING, PROFESSIONAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1588299614
Entity Type Code : Organization
Provider Name (Legal Business Name) : S T REZAI FAMILY COUNSELING, PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 5743 CORSA AVE STE 112
Second Line :
City : WESTLAKE VILLAGE
State : CA
Zip : 91362-6441
Country : US
Telephone Number : 805-229-1887
Fax Number :
Provider Business Practice Location Address
First Line : 5743 CORSA AVE STE 112
Second Line :
City : WESTLAKE VILLAGE
State : CA
Zip : 91362-6441
Country : US
Telephone Number : 805-229-1887
Fax Number :
Authorized Official
Title or Position : CEO
Name : MRS. SEPIDEH TAKMILI REZAI
Credential : LMFT
Telephone Number : 805-229-1887
Provider Enumeration Date : 03/09/2020
Last Update Date : 03/09/2020

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