Provider Demographics
NPI:1437814662
Name:FATAHIAN-TEHRAN, HAMED M (MA, LMFT, LPC)
Entity Type:Individual
Prefix:MR
First Name:HAMED
Middle Name:M
Last Name:FATAHIAN-TEHRAN
Suffix:
Gender:M
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23627 MARSHALL ST.
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:510-449-7475
Mailing Address - Fax:
Practice Address - Street 1:23627 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:408-755-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124635101Y00000X
CA9331101Y00000X
MILPC6401223747101YP2500X
CALMFT139628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional