Provider Demographics
NPI:1629867247
Name:MOGHADAM, MOJIANA ALAILI (LPCC)
Entity type:Individual
Prefix:DR
First Name:MOJIANA
Middle Name:ALAILI
Last Name:MOGHADAM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 COLLEGE BLVD # 102-143
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6263
Mailing Address - Country:US
Mailing Address - Phone:949-312-1797
Mailing Address - Fax:
Practice Address - Street 1:28881 VIA LEONA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-5536
Practice Address - Country:US
Practice Address - Phone:949-312-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16131101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health