Provider Demographics
NPI:1457490682
Name:LUNDQUIST, SIMONE NOUSHIN (MFTI, MHRS)
Entity Type:Individual
Prefix:MISS
First Name:SIMONE
Middle Name:NOUSHIN
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:MFTI, MHRS
Other - Prefix:MISS
Other - First Name:NOUSHIN
Other - Middle Name:
Other - Last Name:KHAYYAMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTI, MHRS
Mailing Address - Street 1:2400 MOORPARK AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2631
Mailing Address - Country:US
Mailing Address - Phone:408-975-2730
Mailing Address - Fax:
Practice Address - Street 1:2400 MOORPARK AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2631
Practice Address - Country:US
Practice Address - Phone:408-975-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist