Provider Demographics
NPI:1750616710
Name:MONTAZERI, PARISA (PSYD)
Entity type:Individual
Prefix:DR
First Name:PARISA
Middle Name:
Last Name:MONTAZERI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 SW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9012
Mailing Address - Country:US
Mailing Address - Phone:580-536-0077
Mailing Address - Fax:580-510-2725
Practice Address - Street 1:1602 SW 82ND ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9012
Practice Address - Country:US
Practice Address - Phone:580-536-0077
Practice Address - Fax:580-510-2725
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist