Provider Demographics
NPI:1518455500
Name:KHAIRANDESH, WAIS IBRAHIM (LPC)
Entity Type:Individual
Prefix:MR
First Name:WAIS
Middle Name:IBRAHIM
Last Name:KHAIRANDESH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 W CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-2707
Mailing Address - Country:US
Mailing Address - Phone:480-308-5478
Mailing Address - Fax:
Practice Address - Street 1:3502 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-2707
Practice Address - Country:US
Practice Address - Phone:480-308-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0194921101YM0800X
AZLPC-21128101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health