Provider Demographics
NPI:1104182153
Name:HAIDER, SHAMSHAD (LPC)
Entity type:Individual
Prefix:MR
First Name:SHAMSHAD
Middle Name:
Last Name:HAIDER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:SHAD
Other - Middle Name:
Other - Last Name:HAIDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1801 OAK CREEK LN APT B
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7912
Mailing Address - Country:US
Mailing Address - Phone:214-454-7860
Mailing Address - Fax:
Practice Address - Street 1:4230 LBJ FWY STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5844
Practice Address - Country:US
Practice Address - Phone:214-454-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66143101YP2500X
TX81047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional