Provider Demographics
NPI:1912458332
Name:MOSSADEGHI, HOMILA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:HOMILA
Middle Name:
Last Name:MOSSADEGHI
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 1:11850 WILSHIRE BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6629
Mailing Address - Country:US
Mailing Address - Phone:310-779-7710
Mailing Address - Fax:310-575-9302
Practice Address - Street 1:11850 WILSHIRE BLVD STE 200A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6629
Practice Address - Country:US
Practice Address - Phone:310-779-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health