Provider Demographics
NPI:1356112734
Name:GHASSEMI, MUSTAFA SADIQ (AMFT)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:SADIQ
Last Name:GHASSEMI
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 PEABODY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6695
Mailing Address - Country:US
Mailing Address - Phone:707-446-8600
Mailing Address - Fax:774-446-8100
Practice Address - Street 1:2050 PEABODY RD STE 300
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6695
Practice Address - Country:US
Practice Address - Phone:707-446-8600
Practice Address - Fax:774-446-8100
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140837106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist