Provider Demographics
NPI:1871147090
Name:AZHDARIANFARD, PARISA
Entity type:Individual
Prefix:
First Name:PARISA
Middle Name:
Last Name:AZHDARIANFARD
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 1:933 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1938
Mailing Address - Country:US
Mailing Address - Phone:312-218-0552
Mailing Address - Fax:
Practice Address - Street 1:1807 HICKS RD STE A
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1243
Practice Address - Country:US
Practice Address - Phone:312-843-0668
Practice Address - Fax:847-233-1349
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL34000101YA0400X
IL178012242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNAOtherNA