Provider Demographics
NPI:1194275081
Name:NOORIZADEH, MONA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:NOORIZADEH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W MCDERMOTT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8058
Mailing Address - Country:US
Mailing Address - Phone:972-954-7188
Mailing Address - Fax:214-383-4252
Practice Address - Street 1:314 W LENNON DR STE A
Practice Address - Street 2:SUITE #118
Practice Address - City:EMORY
Practice Address - State:TX
Practice Address - Zip Code:75440-3062
Practice Address - Country:US
Practice Address - Phone:972-954-7188
Practice Address - Fax:214-383-4252
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37265103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist