MEDICARE: FARIBA NIKDEL M.S. CDP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP00000415	WA

General Provider Information

NPI Number	:	1063911139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARIBA NIKDEL M.S. CDP

Provider Business Mailing Address
First Line	:	PO BOX 4627
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99220-0627
Country	:	US
Telephone Number	:	509-624-1244
Fax Number	:	509-624-6240

Provider Business Practice Location Address
First Line	:	2317 W 3RD AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-5809
Country	:	US
Telephone Number	:	509-624-1244
Fax Number	:	509-624-6240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	02/05/2018

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