Basic Information
| Provider Information | |||||||||
| NPI: | 1568854644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAYSAN-ROOFIAN | ||||||||
| FirstName: | TANAZ | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5554 RESEDA BLVD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913562200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187075522 | ||||||||
| FaxNumber: | 8187050522 | ||||||||
| Practice Location | |||||||||
| Address1: | 5554 RESEDA BLVD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913562200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187075522 | ||||||||
| FaxNumber: | 8187050522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2015 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 38949 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.