Provider Demographics
NPI:1144656760
Name:FERDOUSI, SHADAN NOSHAD (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:SHADAN
Middle Name:NOSHAD
Last Name:FERDOUSI
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 EMMA LOOP
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-1437
Mailing Address - Country:US
Mailing Address - Phone:972-444-8640
Mailing Address - Fax:
Practice Address - Street 1:252 EMMA LOOP
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-9365
Practice Address - Country:US
Practice Address - Phone:972-444-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional