Provider Demographics
NPI:1710658992
Name:KAZEMI, SALOUMEH (MS)
Entity Type:Individual
Prefix:
First Name:SALOUMEH
Middle Name:
Last Name:KAZEMI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:KAZEMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:4655 QUALITY CT STE H
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5231
Mailing Address - Country:US
Mailing Address - Phone:619-890-0790
Mailing Address - Fax:
Practice Address - Street 1:6717 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4137
Practice Address - Country:US
Practice Address - Phone:805-610-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144478106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty