Provider Demographics
NPI:1487010005
Name:NEMATOLLAH, PARHAM (MFT-INTERN , CATC-IV)
Entity Type:Individual
Prefix:
First Name:PARHAM
Middle Name:
Last Name:NEMATOLLAH
Suffix:
Gender:M
Credentials:MFT-INTERN , CATC-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7521 EDINGER AVE
Mailing Address - Street 2:UNIT 2634
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3508
Mailing Address - Country:US
Mailing Address - Phone:949-903-6636
Mailing Address - Fax:
Practice Address - Street 1:19322 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6542
Practice Address - Country:US
Practice Address - Phone:949-258-7579
Practice Address - Fax:949-515-9193
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)