Provider Demographics
NPI:1922578608
Name:FREE YOUR MIND MARRIAGE & FAMILY THERAPY, PROFESSIONAL INC
Entity Type:Organization
Organization Name:FREE YOUR MIND MARRIAGE & FAMILY THERAPY, PROFESSIONAL INC
Other - Org Name:FREE YOUR MIND MARRIAGE & FAMILY THERAPY, PROFESSIONAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBASSI
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LMFT
Authorized Official - Phone:949-520-2720
Mailing Address - Street 1:23152 VERDUGO DR STE 190D
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1363
Mailing Address - Country:US
Mailing Address - Phone:949-520-2720
Mailing Address - Fax:
Practice Address - Street 1:23152 VERDUGO DR STE 190D
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1363
Practice Address - Country:US
Practice Address - Phone:949-520-2720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty