1215364757 NPI number — MRS. ETHEL NAHMAD-FAITH MA, LMFT

Table of content: MRS. ETHEL NAHMAD-FAITH MA, LMFT (NPI 1215364757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215364757 NPI number — MRS. ETHEL NAHMAD-FAITH MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAHMAD-FAITH
Provider First Name:
ETHEL
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215364757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5155 XERXES AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55410-2255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-384-5602
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 E FRANKLIN AVE STE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-2557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-384-5602
Provider Business Practice Location Address Fax Number:
612-465-4567
Provider Enumeration Date:
09/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  2388 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1518053834 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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