Provider Demographics
NPI:1649462789
Name:ALBOUGHOBAISH, PARVANEH I (LMFT)
Entity type:Individual
Prefix:
First Name:PARVANEH
Middle Name:
Last Name:ALBOUGHOBAISH
Suffix:I
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:PARIS
Other - Middle Name:
Other - Last Name:BAISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2178 JOHNSON AVE,
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5230
Mailing Address - Country:US
Mailing Address - Phone:805-781-4768
Mailing Address - Fax:
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9200
Practice Address - Fax:909-421-9219
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health