Provider Demographics
NPI:1346751294
Name:KHAKPOUR, NINA (LMFT)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:KHAKPOUR
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:PO BOX 9261
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91372-9261
Mailing Address - Country:US
Mailing Address - Phone:310-779-0905
Mailing Address - Fax:
Practice Address - Street 1:7247 HAYVENHURST AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2871
Practice Address - Country:US
Practice Address - Phone:818-341-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109204101YA0400X
106H00000X
CA133573106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)