Provider Demographics
NPI:1508215898
Name:BAKHIARI, SEPIDEH (LMFT)
Entity Type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:BAKHIARI
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 1:12 MAYAPPLE WAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2714
Mailing Address - Country:US
Mailing Address - Phone:949-484-8006
Mailing Address - Fax:951-328-0722
Practice Address - Street 1:4199 CAMPUS DR
Practice Address - Street 2:550
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-4684
Practice Address - Country:US
Practice Address - Phone:949-484-8006
Practice Address - Fax:951-328-0722
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT90589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist