Provider Demographics
NPI:1861845919
Name:POURHASSANI, SEPIDEH (MA)
Entity Type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:POURHASSANI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 LIGHTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3489
Mailing Address - Country:US
Mailing Address - Phone:256-468-9665
Mailing Address - Fax:
Practice Address - Street 1:125 COOL SPRINGS BLVD STE 270
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6574
Practice Address - Country:US
Practice Address - Phone:615-338-6341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health