Provider Demographics
NPI:1013146562
Name:AGAHI, AZITA (MFT MASTERS)
Entity Type:Individual
Prefix:
First Name:AZITA
Middle Name:
Last Name:AGAHI
Suffix:
Gender:F
Credentials:MFT MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 CLEARBROOK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7586
Mailing Address - Country:US
Mailing Address - Phone:951-237-7989
Mailing Address - Fax:
Practice Address - Street 1:1200 N MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3632
Practice Address - Country:US
Practice Address - Phone:714-480-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health