1255669156 NPI number — MR. ABDULAHI ABDI MOHAMED LICSW

Table of content: MR. ABDULAHI ABDI MOHAMED LICSW (NPI 1255669156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255669156 NPI number — MR. ABDULAHI ABDI MOHAMED LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOHAMED
Provider First Name:
ABDULAHI
Provider Middle Name:
ABDI
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

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:
1255669156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 E LAKE ST
Provider Second Line Business Mailing Address:
SUITE 2100
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55406-1963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-767-7770
Provider Business Mailing Address Fax Number:
612-767-7772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 E. LAKE STREET
Provider Second Line Business Practice Location Address:
SUITE 2100
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-767-7770
Provider Business Practice Location Address Fax Number:
612-767-7772
Provider Enumeration Date:
12/03/2009

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: 1041C0700X , with the licence number:  17530 , 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: 1568778660 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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