Provider Demographics
NPI:1235606385
Name:MAYEH, ELNAZ (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:ELNAZ
Middle Name:
Last Name:MAYEH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23480 PARK SORRENTO STE 220B
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1356
Mailing Address - Country:US
Mailing Address - Phone:818-943-1369
Mailing Address - Fax:
Practice Address - Street 1:23480 PARK SORRENTO STE 220B
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302
Practice Address - Country:US
Practice Address - Phone:818-943-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99907106H00000X
106H00000X
CA113967106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist