Provider Demographics
NPI:1760653588
Name:DABIRI-FAR, SHAUNA SHABNAM (MS, LMFT 77396)
Entity Type:Individual
Prefix:MISS
First Name:SHAUNA
Middle Name:SHABNAM
Last Name:DABIRI-FAR
Suffix:
Gender:F
Credentials:MS, LMFT 77396
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N EL CENTRO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3805
Mailing Address - Country:US
Mailing Address - Phone:323-769-7118
Mailing Address - Fax:323-463-7033
Practice Address - Street 1:815 N EL CENTRO AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-3805
Practice Address - Country:US
Practice Address - Phone:323-769-7118
Practice Address - Fax:323-463-0619
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF52975106H00000X
106H00000X
CALMFT77396106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist