Healthcare Provider Details

I. General information

NPI: 1972233955
Provider Name (Legal Business Name): KHAWLAH ABDEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 04/30/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 DELMAR BLVD STE B300
SAINT LOUIS MO
63112-3078
US

IV. Provider business mailing address

4547 SHADES CREEK DR
BESSEMER AL
35022-6884
US

V. Phone/Fax

Practice location:
  • Phone: 205-520-8754
  • Fax:
Mailing address:
  • Phone: 205-520-8754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: