Provider Demographics
NPI:1720120983
Name:SAHURI, NABIL MICHAEL (LPC, LCPC)
Entity Type:Individual
Prefix:MR
First Name:NABIL
Middle Name:MICHAEL
Last Name:SAHURI
Suffix:
Gender:M
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010
Mailing Address - Country:US
Mailing Address - Phone:618-978-4366
Mailing Address - Fax:314-351-2940
Practice Address - Street 1:4561 S COMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-1554
Practice Address - Country:US
Practice Address - Phone:314-352-1770
Practice Address - Fax:314-351-2940
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001031963101YP2500X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO188315Medicare UPIN