Healthcare Provider Details

I. General information

NPI: 1699534586
Provider Name (Legal Business Name): GHASSAN IBRAHIM ABUELIAN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 N SCOTTSDALE RD STE A199
SCOTTSDALE AZ
85253-3593
US

IV. Provider business mailing address

7373 N SCOTTSDALE RD STE A199
SCOTTSDALE AZ
85253-3593
US

V. Phone/Fax

Practice location:
  • Phone: 702-805-5360
  • Fax: 702-977-7488
Mailing address:
  • Phone: 702-805-5360
  • Fax: 702-977-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10023455
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0036368
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number242328
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: