Provider Demographics
NPI:1871095562
Name:ARGHAVANI JACKSON, BAHAR
Entity type:Individual
Prefix:
First Name:BAHAR
Middle Name:
Last Name:ARGHAVANI JACKSON
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:PO BOX 530077
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0077
Mailing Address - Country:US
Mailing Address - Phone:818-823-1019
Mailing Address - Fax:
Practice Address - Street 1:5743 CORSA AVE STE 116
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6458
Practice Address - Country:US
Practice Address - Phone:818-823-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist