Provider Demographics
NPI:1700648706
Name:MAHBOOB, NIHA (LPCC)
Entity Type:Individual
Prefix:
First Name:NIHA
Middle Name:
Last Name:MAHBOOB
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 WOODS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8145
Mailing Address - Country:US
Mailing Address - Phone:859-699-1724
Mailing Address - Fax:
Practice Address - Street 1:600 MONTICELLO ST STE 2
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2974
Practice Address - Country:US
Practice Address - Phone:606-401-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY290107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health