Healthcare Provider Details

I. General information

NPI: 1306919782
Provider Name (Legal Business Name): BEHJAT SHIRAZI LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 CARLISLE BLVD NE STE 206
ALBUQUERQUE NM
87107-4849
US

IV. Provider business mailing address

4308 CARLISLE BLVD NE STE 206
ALBUQUERQUE NM
87107-4849
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-0821
  • Fax: 505-899-1369
Mailing address:
  • Phone: 505-263-0821
  • Fax: 505-899-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0962
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: