Provider Demographics
NPI:1194134825
Name:MOZAFARI, NARGIS
Entity type:Individual
Prefix:
First Name:NARGIS
Middle Name:
Last Name:MOZAFARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WAPATO
Mailing Address - State:WA
Mailing Address - Zip Code:98951-1108
Mailing Address - Country:US
Mailing Address - Phone:509-877-4111
Mailing Address - Fax:509-877-7349
Practice Address - Street 1:620 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WAPATO
Practice Address - State:WA
Practice Address - Zip Code:98951-1108
Practice Address - Country:US
Practice Address - Phone:509-877-4111
Practice Address - Fax:509-877-7349
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60914378103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical