Provider Demographics
NPI:1720739824
Name:SHABAHANG, EHSAN ADIB (MS, LPC, LMHC, NCC)
Entity type:Individual
Prefix:MR
First Name:EHSAN
Middle Name:ADIB
Last Name:SHABAHANG
Suffix:
Gender:
Credentials:MS, LPC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 HARRISON AVE
Mailing Address - Street 2:STE 605 PMB 866561
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1929
Mailing Address - Country:US
Mailing Address - Phone:832-850-1283
Mailing Address - Fax:
Practice Address - Street 1:68 HARRISON AVE
Practice Address - Street 2:STE 605 PMB 866561
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1929
Practice Address - Country:US
Practice Address - Phone:832-850-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88146101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor