Provider Demographics
NPI:1801670328
Name:SHADI, ASHKAN RAFAEL (LMFT)
Entity type:Individual
Prefix:
First Name:ASHKAN
Middle Name:RAFAEL
Last Name:SHADI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 ROXBURY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1046
Mailing Address - Country:US
Mailing Address - Phone:310-592-1576
Mailing Address - Fax:
Practice Address - Street 1:1167 ROXBURY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1046
Practice Address - Country:US
Practice Address - Phone:310-592-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT135824102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst