Provider Demographics
NPI:1891134102
Name:KIA, ANAHITA (JD, MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ANAHITA
Middle Name:
Last Name:KIA
Suffix:
Gender:F
Credentials:JD, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28328 AGOURA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2739
Mailing Address - Country:US
Mailing Address - Phone:818-307-6255
Mailing Address - Fax:
Practice Address - Street 1:28328 AGOURA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2739
Practice Address - Country:US
Practice Address - Phone:818-307-6255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT90572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist