Provider Demographics
NPI:1164587432
Name:AHMAD-DERWEESH, BAHEIA ALLAN
Entity Type:Individual
Prefix:
First Name:BAHEIA
Middle Name:ALLAN
Last Name:AHMAD-DERWEESH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BAHEIA
Other - Middle Name:
Other - Last Name:AHMAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:8051 MCVICKER AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1907
Mailing Address - Country:US
Mailing Address - Phone:708-250-5161
Mailing Address - Fax:
Practice Address - Street 1:11227 DISTINCTIVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-250-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional