Healthcare Provider Details

I. General information

NPI: 1134944259
Provider Name (Legal Business Name): ABDALA ABDIRAHMAN MUHUMED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 25TH AVE S STE 108
SAINT CLOUD MN
56301-4810
US

IV. Provider business mailing address

606 25TH AVE S STE 108
SAINT CLOUD MN
56301-4810
US

V. Phone/Fax

Practice location:
  • Phone: 320-240-2913
  • Fax: 320-253-5054
Mailing address:
  • Phone: 616-212-5018
  • Fax: 320-253-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: