Provider Demographics
NPI:1093040347
Name:MOKHTARI, RASOUL (MS BCBA)
Entity Type:Individual
Prefix:
First Name:RASOUL
Middle Name:
Last Name:MOKHTARI
Suffix:
Gender:M
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 LEBANON PIKE # 167
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1316
Mailing Address - Country:US
Mailing Address - Phone:615-476-0401
Mailing Address - Fax:615-777-3210
Practice Address - Street 1:4636 LEBANON PIKE # 167
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1316
Practice Address - Country:US
Practice Address - Phone:615-476-0401
Practice Address - Fax:615-777-3210
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist