Provider Demographics
NPI:1336491810
Name:GHODSI, FRED FARHAD (MA, LMFT 106868)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:FARHAD
Last Name:GHODSI
Suffix:
Gender:M
Credentials:MA, LMFT 106868
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 VAN NESS AVE
Mailing Address - Street 2:SUITE E-3358
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3200
Mailing Address - Country:US
Mailing Address - Phone:415-786-7495
Mailing Address - Fax:
Practice Address - Street 1:1235 MISSION ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103
Practice Address - Country:US
Practice Address - Phone:415-558-4346
Practice Address - Fax:415-558-4705
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106868106H00000X, 101YM0800X, 106H00000X
CA93201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist