Provider Demographics
NPI:1528736121
Name:MAGHSOODI, AMIR H (PHD, LLP)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:H
Last Name:MAGHSOODI
Suffix:
Gender:M
Credentials:PHD, LLP
Other - Prefix:
Other - First Name:HOMAYOON
Other - Middle Name:
Other - Last Name:MAGHSOODI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3135 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3135 PROFESSIONAL DR
Practice Address - Street 2:RM 18
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5131
Practice Address - Country:US
Practice Address - Phone:734-234-6834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351004718103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical