Individual
AZAR NIKRAVESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 N JORDAN AVE, BLOOMINGTON, IN 47405-3190
(812) 855-7338
Mailing address
600 N JORDAN AVE, BLOOMINGTON, IN 47405-3190
(812) 855-7338
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/17/2011
Last updated
10/17/2011
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