Provider Demographics
NPI:1083421531
Name:KHAN, SIDRAH (LPC)
Entity type:Individual
Prefix:
First Name:SIDRAH
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 JACEY WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78725-6375
Mailing Address - Country:US
Mailing Address - Phone:512-844-0944
Mailing Address - Fax:
Practice Address - Street 1:1706 JACEY WAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78725-6375
Practice Address - Country:US
Practice Address - Phone:512-844-0944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional