Provider Demographics
NPI:1558804807
Name:KHODABAKHSH, SAREEN HACOPIANS
Entity Type:Individual
Prefix:
First Name:SAREEN
Middle Name:HACOPIANS
Last Name:KHODABAKHSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 GYRAL DR
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2533
Mailing Address - Country:US
Mailing Address - Phone:818-406-9957
Mailing Address - Fax:
Practice Address - Street 1:6245 GYRAL DR
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2533
Practice Address - Country:US
Practice Address - Phone:818-406-9957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist