Provider Demographics
NPI:1265662639
Name:DJANGI, AHMAD REZA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:REZA
Last Name:DJANGI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 HIGHWAY 95
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7491
Mailing Address - Country:US
Mailing Address - Phone:928-763-7776
Mailing Address - Fax:928-763-7786
Practice Address - Street 1:2580 HIGHWAY 95
Practice Address - Street 2:SUITE 120
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7491
Practice Address - Country:US
Practice Address - Phone:928-763-7776
Practice Address - Fax:928-763-7786
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional