Provider Demographics
NPI:1770123390
Name:AKBARPOUR, VANESA ALICIA
Entity type:Individual
Prefix:
First Name:VANESA
Middle Name:ALICIA
Last Name:AKBARPOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22654 MARLIN PL
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2625
Mailing Address - Country:US
Mailing Address - Phone:818-456-6455
Mailing Address - Fax:
Practice Address - Street 1:21201 VICTORY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91303-2866
Practice Address - Country:US
Practice Address - Phone:818-334-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT110378106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist