Provider Demographics
NPI:1326378738
Name:FARHAD, YASAMIN (LMFT, PHD)
Entity Type:Individual
Prefix:DR
First Name:YASAMIN
Middle Name:
Last Name:FARHAD
Suffix:
Gender:F
Credentials:LMFT, PHD
Other - Prefix:DR
Other - First Name:YASAMIN
Other - Middle Name:
Other - Last Name:FARHAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2601 E CHAPMAN AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3737
Mailing Address - Country:US
Mailing Address - Phone:949-293-6249
Mailing Address - Fax:
Practice Address - Street 1:2601 E CHAPMAN AVE STE 111
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3737
Practice Address - Country:US
Practice Address - Phone:949-293-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81557106H00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1327270OtherMEDI-CAL
12787872OtherCAQH