Provider Demographics
NPI:1649597162
Name:AFSAHI, AZADEH (LMFT)
Entity Type:Individual
Prefix:
First Name:AZADEH
Middle Name:
Last Name:AFSAHI
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 1:1120 W AVENUE M4
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1432
Mailing Address - Country:US
Mailing Address - Phone:661-480-2377
Mailing Address - Fax:661-480-2378
Practice Address - Street 1:1120 W AVENUE M4
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1432
Practice Address - Country:US
Practice Address - Phone:661-480-2377
Practice Address - Fax:661-480-2378
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CALMFT99240106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No172V00000XOther Service ProvidersCommunity Health Worker