Provider Information for 1932627288
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Mrs. SHIRIN TAVAKOL LPC-I
Sex: Female
NPI: 1932627288
Last Updated: 2017-09-07
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1932627288 | ||||||||
| Enumeration Date | 2017-09-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 218 N COLLEGE AVE TYLER, TX 75702-5715 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 218 N COLLEGE AVE TYLER, TX 75702-5715 United States Phone: 903-593-9141 | Fax: | ||||||||
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