Provider Demographics
NPI:1871231852
Name:FARAHVASHI, MARYAM (SOCIAL WORKER, LCDC)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:FARAHVASHI
Suffix:
Gender:F
Credentials:SOCIAL WORKER, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MAIN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3230
Mailing Address - Country:US
Mailing Address - Phone:328-474-8368
Mailing Address - Fax:832-847-4852
Practice Address - Street 1:1601 MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3230
Practice Address - Country:US
Practice Address - Phone:328-474-8368
Practice Address - Fax:832-847-4852
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker