Provider Demographics
NPI:1649514266
Name:KHAN, FAHAD HABIB (PSYD)
Entity type:Individual
Prefix:DR
First Name:FAHAD
Middle Name:HABIB
Last Name:KHAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 N LOMBARD RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-1264
Mailing Address - Country:US
Mailing Address - Phone:630-474-4414
Mailing Address - Fax:630-230-3364
Practice Address - Street 1:998 N LOMBARD RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-474-4414
Practice Address - Fax:630-230-3364
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008538101YP2500X
IL180009783101YP2500X
IL071009813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional