Basic Information
| Provider Information | |||||||||
| NPI: | 1255866265 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAHABIR LPC PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1640 HASLETT RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | HASLETT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488408691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178988541 | ||||||||
| FaxNumber: | 5173239531 | ||||||||
| Practice Location | |||||||||
| Address1: | 1640 HASLETT RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | HASLETT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488408691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178988541 | ||||||||
| FaxNumber: | 5173239531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2017 | ||||||||
| LastUpdateDate: | 04/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | MAHABIR | ||||||||
| AuthorizedOfficialFirstName: | GITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5178988541 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401011156 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.