Provider Demographics
NPI:1730867177
Name:FERESHTE MIRZAD, PSYCHOLOGIST P.C.
Entity type:Organization
Organization Name:FERESHTE MIRZAD, PSYCHOLOGIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FERESHTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-274-8056
Mailing Address - Street 1:18811 HUNTINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6003
Mailing Address - Country:US
Mailing Address - Phone:818-274-8056
Mailing Address - Fax:
Practice Address - Street 1:18811 HUNTINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6003
Practice Address - Country:US
Practice Address - Phone:818-274-8056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty