Provider Demographics
NPI:1518484914
Name:MH4M COUNSELING AND EDUCATION CENTER, PLLC
Entity Type:Organization
Organization Name:MH4M COUNSELING AND EDUCATION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAFISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEKANDARI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:623-512-4853
Mailing Address - Street 1:12725 W INDIAN SCHOOL RD STE E101
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-9525
Mailing Address - Country:US
Mailing Address - Phone:623-512-4853
Mailing Address - Fax:623-505-4808
Practice Address - Street 1:12725 W INDIAN SCHOOL RD STE E101
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9525
Practice Address - Country:US
Practice Address - Phone:623-512-4853
Practice Address - Fax:623-505-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ4243103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1073890307OtherSCHOOL DISTRICT