Provider Demographics
NPI:1801027594
Name:HOLAKOUEE, TABASOM (PHD)
Entity Type:Individual
Prefix:
First Name:TABASOM
Middle Name:
Last Name:HOLAKOUEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-5040
Mailing Address - Country:US
Mailing Address - Phone:323-813-6070
Mailing Address - Fax:
Practice Address - Street 1:1762 WESTWOOD BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5632
Practice Address - Country:US
Practice Address - Phone:323-813-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26143103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical