Provider Demographics
NPI:1134520059
Name:AURASTEH, POORANG (MA, LMFT)
Entity type:Individual
Prefix:
First Name:POORANG
Middle Name:
Last Name:AURASTEH
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 MANCHESTER AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4900
Mailing Address - Country:US
Mailing Address - Phone:949-422-8288
Mailing Address - Fax:
Practice Address - Street 1:4407 MANCHESTER AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4900
Practice Address - Country:US
Practice Address - Phone:949-422-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist