Provider Demographics
NPI:1679288815
Name:NEKBEEN, MITRA F (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MITRA
Middle Name:F
Last Name:NEKBEEN
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 1:800 DAVIS STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN LEANDORO
Mailing Address - State:CA
Mailing Address - Zip Code:94577
Mailing Address - Country:US
Mailing Address - Phone:510-618-7744
Mailing Address - Fax:510-618-7794
Practice Address - Street 1:2208 SAN LEANDRO BLVD.
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577
Practice Address - Country:US
Practice Address - Phone:510-483-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT103837106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist