Provider Demographics
NPI:1245738830
Name:DR. SHIRIN TABIB LLC
Entity Type:Organization
Organization Name:DR. SHIRIN TABIB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TABIB
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-903-9181
Mailing Address - Street 1:61133 SAN VINCENT BLVD
Mailing Address - Street 2:SUITE 318 A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:61133 SAN VINCENT BLVD
Practice Address - Street 2:SUITE 318 A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-903-9181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty