Provider Demographics
NPI:1982347878
Name:AKHAVAN GOORAN, MARIEH
Entity Type:Individual
Prefix:
First Name:MARIEH
Middle Name:
Last Name:AKHAVAN GOORAN
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 1:4001 S WATT AVE APT 150
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-4492
Mailing Address - Country:US
Mailing Address - Phone:619-436-6536
Mailing Address - Fax:
Practice Address - Street 1:4001 S WATT AVE APT 150
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-4492
Practice Address - Country:US
Practice Address - Phone:619-436-6536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist