Provider Demographics
NPI:1144695032
Name:KHOSRAVI, SHIRIN (PHD, LPC)
Entity type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:KHOSRAVI
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 MCDERMOTT RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7746
Mailing Address - Country:US
Mailing Address - Phone:214-436-3705
Mailing Address - Fax:
Practice Address - Street 1:5200 MCDERMOTT RD STE 225
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7746
Practice Address - Country:US
Practice Address - Phone:214-436-3705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional