Provider Demographics
NPI:1629460811
Name:AKHTARZAD, TERRY (MA)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:AKHTARZAD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TOURAN
Other - Middle Name:
Other - Last Name:AKHTARZAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:16133 VENTURA BLVD STE 1125
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2424
Mailing Address - Country:US
Mailing Address - Phone:310-804-6962
Mailing Address - Fax:
Practice Address - Street 1:16133 VENTURA BLVD STE 1125
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2424
Practice Address - Country:US
Practice Address - Phone:310-804-6962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83705106H00000X
CA103315106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist