Provider Demographics
NPI:1205596632
Name:RIAZ, MISHAAL (MA, LPC)
Entity type:Individual
Prefix:
First Name:MISHAAL
Middle Name:
Last Name:RIAZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N BISHOP AVE APT 369
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1373
Mailing Address - Country:US
Mailing Address - Phone:972-765-2143
Mailing Address - Fax:
Practice Address - Street 1:1901 N CENTRAL EXPY STE 220
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3774
Practice Address - Country:US
Practice Address - Phone:972-765-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health