Provider Demographics
NPI:1144954181
Name:SHALCHIAN POURKHALJAN, SADAF (LMFT)
Entity type:Individual
Prefix:
First Name:SADAF
Middle Name:
Last Name:SHALCHIAN POURKHALJAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SADAF
Other - Middle Name:
Other - Last Name:SHALCHIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26895 ALISO CREEK RD # B-193
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5301
Mailing Address - Country:US
Mailing Address - Phone:949-257-2229
Mailing Address - Fax:
Practice Address - Street 1:28520 WOOD CANYON DR APT 14
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4206
Practice Address - Country:US
Practice Address - Phone:949-257-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133683106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist