Provider Demographics
NPI:1720739824
Name:SHABAHANG, EHSAN ADIB (MS, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:EHSAN
Middle Name:ADIB
Last Name:SHABAHANG
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 SOWDEN RD
Mailing Address - Street 2:STE B, PMB 866561
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-2059
Mailing Address - Country:US
Mailing Address - Phone:832-850-1283
Mailing Address - Fax:
Practice Address - Street 1:12333 SOWDEN RD
Practice Address - Street 2:STE B, PMB 866561
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-2059
Practice Address - Country:US
Practice Address - Phone:832-850-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88146101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor