Provider Demographics
NPI:1669137220
Name:MOUSSAVIAN, NEGEEN (LMFT)
Entity type:Individual
Prefix:
First Name:NEGEEN
Middle Name:
Last Name:MOUSSAVIAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9663
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-4663
Mailing Address - Country:US
Mailing Address - Phone:858-952-9270
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD STE 605
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2609
Practice Address - Country:US
Practice Address - Phone:347-943-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist