Basic Information
| Provider Information | |||||||||
| NPI: | 1356414148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAHRIARI | ||||||||
| FirstName: | KUROSH | ||||||||
| MiddleName: | REX | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ED.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 306 N 3RD AVE E | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502083298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417924012 | ||||||||
| FaxNumber: | 6417910697 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 N 3RD AVE E | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502083298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417924012 | ||||||||
| FaxNumber: | 6417910697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 00382 | IA | X | Behavioral Health & Social Service Providers | Psychologist | 103TH0100X | 00059 | IA | X | Behavioral Health & Social Service Providers | Psychologist | Health Service |
No ID Information.