Healthcare Provider Details

I. General information

NPI: 1720120983
Provider Name (Legal Business Name): NABIL MICHAEL SAHURI L.P.C., L.C.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4561 S COMPTON AVE
SAINT LOUIS MO
63111-1554
US

IV. Provider business mailing address

402 OREGON ST
BETHALTO IL
62010
US

V. Phone/Fax

Practice location:
  • Phone: 314-352-1770
  • Fax: 314-351-2940
Mailing address:
  • Phone: 618-978-4366
  • Fax: 314-351-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001031963
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: