Provider Demographics
NPI:1467822395
Name:MAZHAR, PARISA
Entity Type:Individual
Prefix:
First Name:PARISA
Middle Name:
Last Name:MAZHAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 SW CONESTOGA DR
Mailing Address - Street 2:#173
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8403
Mailing Address - Country:US
Mailing Address - Phone:360-253-6019
Mailing Address - Fax:360-253-6098
Practice Address - Street 1:9902 SW CONESTOGA DR
Practice Address - Street 2:#173
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-8403
Practice Address - Country:US
Practice Address - Phone:360-253-6019
Practice Address - Fax:360-253-6098
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60161090104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker