Provider Demographics
NPI:1639256308
Name:KHAN, FAWZIA AZIZ (MBS)
Entity Type:Individual
Prefix:MS
First Name:FAWZIA
Middle Name:AZIZ
Last Name:KHAN
Suffix:
Gender:F
Credentials:MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220D N SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7465
Mailing Address - Country:US
Mailing Address - Phone:903-868-2961
Mailing Address - Fax:903-892-2265
Practice Address - Street 1:220D N SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7465
Practice Address - Country:US
Practice Address - Phone:903-868-2961
Practice Address - Fax:903-892-2265
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171457801Medicaid