Provider Demographics
NPI:1508227158
Name:KHAN, NAZIA A (MS)
Entity Type:Individual
Prefix:
First Name:NAZIA
Middle Name:A
Last Name:KHAN
Suffix:
Gender:F
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:PO BOX 1257
Mailing Address - Street 2:CHILD ABUSE PREVENTION COUNCIL
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95201-1257
Mailing Address - Country:US
Mailing Address - Phone:209-636-7258
Mailing Address - Fax:209-227-7255
Practice Address - Street 1:127 N. SUTTER STREET
Practice Address - Street 2:CHILD ABUSE PREVENTION COUNCIL
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202
Practice Address - Country:US
Practice Address - Phone:209-636-7258
Practice Address - Fax:209-227-7255
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1634101YP2500X
CA83839106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD5283974OtherCA DRIVER LICENSE