Provider Demographics
NPI:1083224158
Name:SIVAKUMARAN, AHILLAN (LPC)
Entity Type:Individual
Prefix:
First Name:AHILLAN
Middle Name:
Last Name:SIVAKUMARAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:SIVAKUMARAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1032 MADELIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-1072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7535 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4236
Practice Address - Country:US
Practice Address - Phone:800-972-0643
Practice Address - Fax:214-279-5032
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73197101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor