Provider Demographics
NPI:1538599774
Name:GHEISAR-SHAHABIAN, JZEELA (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JZEELA
Middle Name:
Last Name:GHEISAR-SHAHABIAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:JZEELA
Other - Middle Name:
Other - Last Name:GHEISAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:4190 DOUGLAS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95746-5918
Mailing Address - Country:US
Mailing Address - Phone:916-520-6303
Mailing Address - Fax:916-771-2080
Practice Address - Street 1:4190 DOUGLAS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95746-5918
Practice Address - Country:US
Practice Address - Phone:916-520-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98994106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist