Provider Demographics
NPI:1568854644
Name:NAYSAN-ROOFIAN, TANAZ (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:TANAZ
Middle Name:
Last Name:NAYSAN-ROOFIAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5554 RESEDA BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2200
Mailing Address - Country:US
Mailing Address - Phone:818-707-5522
Mailing Address - Fax:818-705-0522
Practice Address - Street 1:5554 RESEDA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2200
Practice Address - Country:US
Practice Address - Phone:818-707-5522
Practice Address - Fax:818-705-0522
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist