Provider Demographics
NPI:1497263958
Name:KHALILI-TARI, SEPEHR (MS)
Entity Type:Individual
Prefix:
First Name:SEPEHR
Middle Name:
Last Name:KHALILI-TARI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 N 152ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8137
Mailing Address - Country:US
Mailing Address - Phone:402-212-0251
Mailing Address - Fax:
Practice Address - Street 1:3223 N 169TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2650
Practice Address - Country:US
Practice Address - Phone:402-813-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health