Provider Demographics
NPI:1023801792
Name:KIANPOUR, MAANI
Entity type:Individual
Prefix:
First Name:MAANI
Middle Name:
Last Name:KIANPOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12025 RICHMOND AVE APT 13209
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2497
Mailing Address - Country:US
Mailing Address - Phone:713-530-5734
Mailing Address - Fax:
Practice Address - Street 1:12025 RICHMOND AVE APT 13209
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2497
Practice Address - Country:US
Practice Address - Phone:713-530-5734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-25-413025106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician