Provider Demographics
NPI:1699388892
Name:POURTAHMASEB-SASI, DAMON (LMFT)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:POURTAHMASEB-SASI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 NE 199TH ST APT 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3067
Mailing Address - Country:US
Mailing Address - Phone:786-271-4868
Mailing Address - Fax:
Practice Address - Street 1:761 NE 199TH ST APT 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-3067
Practice Address - Country:US
Practice Address - Phone:786-271-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3419106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist