Healthcare Provider Details

I. General information

NPI: 1326718958
Provider Name (Legal Business Name): EHSAN A MOHAMED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 EARLE BROWN DR STE 300
BROOKLYN CENTER MN
55430-4523
US

IV. Provider business mailing address

6040 EARLE BROWN DR STE 300
BROOKLYN CENTER MN
55430-4523
US

V. Phone/Fax

Practice location:
  • Phone: 763-999-5938
  • Fax: 612-326-6160
Mailing address:
  • Phone: 763-999-5938
  • Fax: 612-326-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: