Provider Demographics
NPI:1972241610
Name:MORADIAN, MICHAEL AZAD (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AZAD
Last Name:MORADIAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 CANBY AVE UNIT 4
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1384
Mailing Address - Country:US
Mailing Address - Phone:818-434-9692
Mailing Address - Fax:818-700-0933
Practice Address - Street 1:8055 CANBY AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1384
Practice Address - Country:US
Practice Address - Phone:818-434-9692
Practice Address - Fax:818-700-0933
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132857106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty