Provider Demographics
NPI:1265962179
Name:MAHBOBIAN, SHERRY (MS, LPC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:MAHBOBIAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 E PARK PL APT 210C
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3593
Mailing Address - Country:US
Mailing Address - Phone:414-630-8755
Mailing Address - Fax:
Practice Address - Street 1:1824 E PARK PL APT 210C
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-3593
Practice Address - Country:US
Practice Address - Phone:414-630-8755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5313-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health