Provider Demographics
NPI:1518336247
Name:BAHRAINI, MANYA HADAEGH (LPC, JD, CDR)
Entity Type:Individual
Prefix:
First Name:MANYA
Middle Name:HADAEGH
Last Name:BAHRAINI
Suffix:
Gender:F
Credentials:LPC, JD, CDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 N WESTERN AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2548
Mailing Address - Country:US
Mailing Address - Phone:312-613-6323
Mailing Address - Fax:
Practice Address - Street 1:5151 N WESTERN AVE # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2548
Practice Address - Country:US
Practice Address - Phone:312-613-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health