Provider Demographics
NPI:1194066134
Name:MORADI, MAHTAB (LMFT)
Entity type:Individual
Prefix:
First Name:MAHTAB
Middle Name:
Last Name:MORADI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S SHORE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2944
Mailing Address - Country:US
Mailing Address - Phone:832-205-8658
Mailing Address - Fax:
Practice Address - Street 1:2600 S SHORE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2944
Practice Address - Country:US
Practice Address - Phone:832-205-8658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5165106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist