Provider Demographics
NPI:1619711702
Name:MAGHSOUDI, MAHSA
Entity type:Individual
Prefix:
First Name:MAHSA
Middle Name:
Last Name:MAGHSOUDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W DOUGLAS AVE STE 625
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2916
Mailing Address - Country:US
Mailing Address - Phone:316-302-5083
Mailing Address - Fax:
Practice Address - Street 1:300 W DOUGLAS AVE STE 625
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2916
Practice Address - Country:US
Practice Address - Phone:316-302-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80829101YM0800X
KS03045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health