Provider Demographics
NPI:1144984568
Name:THERAPY WITH AMIR LICENSED PROFESSIONAL CLINICAL COUNSELOR INC.
Entity type:Organization
Organization Name:THERAPY WITH AMIR LICENSED PROFESSIONAL CLINICAL COUNSELOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:313-296-8734
Mailing Address - Street 1:10231 REFLECTION LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7103
Mailing Address - Country:US
Mailing Address - Phone:313-296-8734
Mailing Address - Fax:
Practice Address - Street 1:1824 BELMONT PL
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-8418
Practice Address - Country:US
Practice Address - Phone:313-296-8734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty