MEDICARE: SELI FAKORZI

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	101YP2500X	Professional Counselor	69281	TX

General Provider Information

NPI Number	:	1093113136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELI FAKORZI

Provider Business Mailing Address
First Line	:	6901 HANSELL RD
Second Line	:	APT 6425
City	:	PLANO
State	:	TX
Zip	:	75024-4214
Country	:	US
Telephone Number	:	214-789-7234
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 HANSELL RD
Second Line	:	APT 6425
City	:	PLANO
State	:	TX
Zip	:	75024-4214
Country	:	US
Telephone Number	:	214-789-7234
Fax Number	:

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

Provider Enumeration Date	:	12/05/2014
Last Update Date	:	12/05/2014

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Directions to “ SELI FAKORZI ” Practice Location

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