Provider Demographics
NPI:1609077056
Name:VAKILI KHATIBLOO, FROOGH A (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:FROOGH
Middle Name:A
Last Name:VAKILI KHATIBLOO
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 LITTLE YORK RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2409
Mailing Address - Country:US
Mailing Address - Phone:937-454-0092
Mailing Address - Fax:937-264-1101
Practice Address - Street 1:28 E RAHN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5461
Practice Address - Country:US
Practice Address - Phone:937-454-0092
Practice Address - Fax:937-264-1101
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health