Provider Demographics
NPI:1063505618
Name:AKHTEH, GOLENA
Entity Type:Individual
Prefix:
First Name:GOLENA
Middle Name:
Last Name:AKHTEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1122
Mailing Address - Country:US
Mailing Address - Phone:310-576-1308
Mailing Address - Fax:310-576-1027
Practice Address - Street 1:3435 OCEAN PARK BLVD #207
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3314
Practice Address - Country:US
Practice Address - Phone:310-392-9474
Practice Address - Fax:310-392-7341
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA79999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health