Provider Demographics
NPI:1659135564
Name:SHAHROKH, SANDRA (LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SHAHROKH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15231 MAGNOLIA BLVD UNIT 218
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15300 VENTURA BLVD STE 408
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5848
Practice Address - Country:US
Practice Address - Phone:818-732-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144838106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist