Provider Demographics
NPI:1326663345
Name:WAX, SHEAVA OKHOVAT (LMFT)
Entity Type:Individual
Prefix:
First Name:SHEAVA
Middle Name:OKHOVAT
Last Name:WAX
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 1:6190 SUMMIT CREST CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5035
Mailing Address - Country:US
Mailing Address - Phone:310-927-2820
Mailing Address - Fax:
Practice Address - Street 1:3150 PIO PICO DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:619-431-0527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116753106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist