Provider Demographics
NPI:1386329480
Name:HASSAN, TAHIRA MOIN (LPC-A)
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:MOIN
Last Name:HASSAN
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 LAS BRISAS DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-9045
Mailing Address - Country:US
Mailing Address - Phone:214-995-9350
Mailing Address - Fax:
Practice Address - Street 1:4100 LAS BRISAS DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-9045
Practice Address - Country:US
Practice Address - Phone:214-995-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health