Provider Demographics
NPI:1639561046
Name:KHAN, SEAN (LMHC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 NE 45TH ST
Mailing Address - Street 2:122
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5131
Mailing Address - Country:US
Mailing Address - Phone:954-775-7369
Mailing Address - Fax:
Practice Address - Street 1:1919 NE 45TH ST
Practice Address - Street 2:SUITE 122
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5131
Practice Address - Country:US
Practice Address - Phone:954-775-7369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-22
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health