Provider Demographics
NPI:1114058740
Name:REDD, IYASHEMA (MFTI, PPS)
Entity Type:Individual
Prefix:
First Name:IYASHEMA
Middle Name:
Last Name:REDD
Suffix:
Gender:F
Credentials:MFTI, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26766 CLAUDETTE ST
Mailing Address - Street 2:UNIT 414
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-5588
Mailing Address - Country:US
Mailing Address - Phone:661-266-4783
Mailing Address - Fax:661-266-1210
Practice Address - Street 1:190 SIERRA CT
Practice Address - Street 2:C-8
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7607
Practice Address - Country:US
Practice Address - Phone:661-266-4783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF49096106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist