Provider Demographics
NPI:1093134975
Name:KHALID, TAHIRA HASSANEIN (LMSWCSW)
Entity Type:Individual
Prefix:MS
First Name:TAHIRA
Middle Name:HASSANEIN
Last Name:KHALID
Suffix:
Gender:F
Credentials:LMSWCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PEARL ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2663
Mailing Address - Country:US
Mailing Address - Phone:734-485-8547
Mailing Address - Fax:
Practice Address - Street 1:124 PEARL ST
Practice Address - Street 2:SUITE 308
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2663
Practice Address - Country:US
Practice Address - Phone:734-485-8547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801063201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional