Provider Demographics
NPI:1275699340
Name:TAVAKOLI, SHAHINE (MA,LPC,LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SHAHINE
Middle Name:
Last Name:TAVAKOLI
Suffix:
Gender:F
Credentials:MA,LPC,LMFT
Other - Prefix:MRS
Other - First Name:SHAHINE
Other - Middle Name:
Other - Last Name:TAVAKOLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,LPC,LMFT
Mailing Address - Street 1:5959 WEST LOOP S STE 600
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2425
Mailing Address - Country:US
Mailing Address - Phone:713-686-3121
Mailing Address - Fax:713-669-0704
Practice Address - Street 1:5959 WEST LOOP S STE 600
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2425
Practice Address - Country:US
Practice Address - Phone:713-686-3121
Practice Address - Fax:713-669-0704
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10312101YP2500X
TX2192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist