Provider Demographics
NPI:1851055735
Name:SHAHBAZI, ANAHITA (LMFT)
Entity Type:Individual
Prefix:
First Name:ANAHITA
Middle Name:
Last Name:SHAHBAZI
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:PO BOX 262011
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-2011
Mailing Address - Country:US
Mailing Address - Phone:619-630-9453
Mailing Address - Fax:
Practice Address - Street 1:17140 BERNARDO CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2000
Practice Address - Country:US
Practice Address - Phone:858-716-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124201106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty