Provider Demographics
NPI:1689731424
Name:NOURI, FARNOOSH MASSOUDIAN (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:FARNOOSH
Middle Name:MASSOUDIAN
Last Name:NOURI
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:MRS
Other - First Name:FAITH
Other - Middle Name:M
Other - Last Name:NOURI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:6643 MIMMS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5480
Mailing Address - Country:US
Mailing Address - Phone:972-992-3992
Mailing Address - Fax:972-992-3992
Practice Address - Street 1:3001 LYNDON B JOHNSON FWY STE 127
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7756
Practice Address - Country:US
Practice Address - Phone:972-992-3992
Practice Address - Fax:972-992-3992
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18285101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional