Provider Demographics
NPI:1427594852
Name:SHAKTI, TARA (MA, MFTI)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SHAKTI
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 WESTWOOD BLVD
Mailing Address - Street 2:#9
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4941
Mailing Address - Country:US
Mailing Address - Phone:310-694-2396
Mailing Address - Fax:
Practice Address - Street 1:1328 WESTWOOD BLVD
Practice Address - Street 2:#9
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4941
Practice Address - Country:US
Practice Address - Phone:310-694-2396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist