Provider Demographics
NPI:1093113136
Name:FAKORZI, SELI
Entity Type:Individual
Prefix:
First Name:SELI
Middle Name:
Last Name:FAKORZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 HANSELL RD
Mailing Address - Street 2:APT 6425
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4214
Mailing Address - Country:US
Mailing Address - Phone:214-789-7234
Mailing Address - Fax:
Practice Address - Street 1:6901 HANSELL RD
Practice Address - Street 2:APT 6425
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4214
Practice Address - Country:US
Practice Address - Phone:214-789-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional