Provider Demographics
NPI:1467927103
Name:BAKHSHI, KHIZRAN MARIAM (BCBA)
Entity Type:Individual
Prefix:
First Name:KHIZRAN
Middle Name:MARIAM
Last Name:BAKHSHI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 SNOWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5965
Mailing Address - Country:US
Mailing Address - Phone:773-786-9325
Mailing Address - Fax:
Practice Address - Street 1:1312 SNOWBERRY LN
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-5965
Practice Address - Country:US
Practice Address - Phone:773-786-9325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty