Provider Demographics
NPI:1205294543
Name:TAHBAZ, ASH (LMFT)
Entity type:Individual
Prefix:
First Name:ASH
Middle Name:
Last Name:TAHBAZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:ASHKAN
Other - Middle Name:
Other - Last Name:TAHBAZZADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10201 MISSION GORGE RD STE O
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3027
Mailing Address - Country:US
Mailing Address - Phone:619-383-6868
Mailing Address - Fax:
Practice Address - Street 1:5454 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3621
Practice Address - Country:US
Practice Address - Phone:619-515-2300
Practice Address - Fax:619-269-0674
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87601106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205294543Medicaid