Provider Demographics
NPI:1518355957
Name:FAZILI, SHEEBA (LPC)
Entity Type:Individual
Prefix:
First Name:SHEEBA
Middle Name:
Last Name:FAZILI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12609 WALMER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3209
Mailing Address - Country:US
Mailing Address - Phone:913-339-9292
Mailing Address - Fax:
Practice Address - Street 1:8801 EAST, 63 RD STREET, RAYTOWN
Practice Address - Street 2:SUITE 101
Practice Address - City:MISSOURI
Practice Address - State:KS
Practice Address - Zip Code:64133
Practice Address - Country:US
Practice Address - Phone:816-368-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional