SHIRAZ P TATA Clinical Psychologist License verification

Business Entity

ACTIVE

License Type

Clinical Psychologist

Description

CLINICAL PSYCHOLOGIST

License Number

071004963

License Status

ACTIVE

Business

First Name

SHIRAZ P

Last Name

TATA

Business Name

SHIRAZ P TATA

Original Issue Date

12/02/1994

Effective Date

09/26/2024

Expiration Date

09/30/2026

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/26/2024