Provider Demographics
NPI:1952809899
Name:GHANATABADI, SHIREEN JUNE (MA, LPCC)
Entity Type:Individual
Prefix:MS
First Name:SHIREEN
Middle Name:JUNE
Last Name:GHANATABADI
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 MADISON ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2844
Mailing Address - Country:US
Mailing Address - Phone:612-638-8838
Mailing Address - Fax:
Practice Address - Street 1:2546 JOHNSON ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3941
Practice Address - Country:US
Practice Address - Phone:612-444-1655
Practice Address - Fax:612-446-5787
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional