Provider Demographics
NPI:1629464441
Name:RASHIDIAN, MITRA (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:MITRA
Middle Name:
Last Name:RASHIDIAN
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 VENTURA BLVD.
Mailing Address - Street 2:SUITE 520
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-422-0375
Mailing Address - Fax:818-506-8009
Practice Address - Street 1:15720 VENTURA BLVD.
Practice Address - Street 2:SUITE 520
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-422-0375
Practice Address - Fax:818-506-8009
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT84702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist