Healthcare Provider Details

I. General information

NPI: 1316935224
Provider Name (Legal Business Name): MUSTAFA AL'ABSI PH. D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 UNIVERSITY DR 236, CENTER FOR RURAL MENTAL HEALTH STUDIES, MED.SCHOOL
DULUTH MN
55812-3031
US

IV. Provider business mailing address

1035 UNIVERSITY DR 236, CENTER FOR RURAL MENTAL HEALTH STUDIES, MED.SCHOOL
DULUTH MN
55812-3031
US

V. Phone/Fax

Practice location:
  • Phone: 218-726-7144
  • Fax:
Mailing address:
  • Phone: 218-726-7144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4233
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: