Provider Demographics
NPI:1083845564
Name:TALEI, BAHAREH (PSYD)
Entity Type:Individual
Prefix:
First Name:BAHAREH
Middle Name:
Last Name:TALEI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26500 AGOURA RD
Mailing Address - Street 2:102-401
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1952
Mailing Address - Country:US
Mailing Address - Phone:818-307-0741
Mailing Address - Fax:818-394-6409
Practice Address - Street 1:30125 AGOURA RD STE 2B
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4345
Practice Address - Country:US
Practice Address - Phone:818-307-0741
Practice Address - Fax:818-394-6409
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21252103TC0700X
103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities