MEDICARE: MOUNIR B IBRAHIM LPCC MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	CDCA.164911	OH
2	101YP2500X	Professional Counselor	LPCC-E.2606124	OH

General Provider Information

NPI Number	:	1063902070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOUNIR B IBRAHIM LPCC MA

Provider Business Mailing Address
First Line	:	843 N CLEVE MASS RD
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-2184
Country	:	US
Telephone Number	:	330-723-7977
Fax Number	:	330-725-5177

Provider Business Practice Location Address
First Line	:	843 N CLEVE MASS RD
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-2184
Country	:	US
Telephone Number	:	330-723-7977
Fax Number	:	330-725-5177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	04/10/2026

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