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NPI Code Detail

MEDICARE: HUSAM AHMAD ABDULKHALEQ LPC

MEDICARE: HUSAM AHMAD ABDULKHALEQ LPC
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
1101YM0800XMental Health Counselor6401007930MI

General Provider Information

NPI Number : 1194082081
Entity Type Code : Individual
Provider Name (Legal Business Name) : HUSAM AHMAD ABDULKHALEQ LPC
Provider Business Mailing Address
First Line : 6450 MAPLE ST
Second Line :
City : DEARBORN
State : MI
Zip : 48126-2259
Country : US
Telephone Number : 313-216-2242
Fax Number : 313-584-3622
Provider Business Practice Location Address
First Line : 6450 MAPLE ST
Second Line :
City : DEARBORN
State : MI
Zip : 48126-2259
Country : US
Telephone Number : 313-216-2242
Fax Number : 313-584-3622
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2012
Last Update Date : 04/16/2012

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