Provider Demographics
NPI:1730238296
Name:MOGHIMI, TARANEH M (LPC, NCC)
Entity type:Individual
Prefix:
First Name:TARANEH
Middle Name:M
Last Name:MOGHIMI
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:FERREIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:6025 SPRING FLOWER TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2132
Mailing Address - Country:US
Mailing Address - Phone:214-207-3484
Mailing Address - Fax:
Practice Address - Street 1:555 REPUBLIC DR STE 109
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5427
Practice Address - Country:US
Practice Address - Phone:214-207-3484
Practice Address - Fax:972-509-9062
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19773101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional