Provider Demographics
NPI:1467854745
Name:MOEIN, TANNAZ
Entity Type:Individual
Prefix:
First Name:TANNAZ
Middle Name:
Last Name:MOEIN
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 1:6737 FIRENZE LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2279
Mailing Address - Country:US
Mailing Address - Phone:903-330-1928
Mailing Address - Fax:
Practice Address - Street 1:4817 MEDICAL CENTER DR UNIT 3A
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1886
Practice Address - Country:US
Practice Address - Phone:972-607-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional