Healthcare Provider Details

I. General information

NPI: 1649320888
Provider Name (Legal Business Name): HUMERA MAHMOOD IMFT, LCDCIII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 S LIBERTY ST
POWELL OH
43065-9301
US

IV. Provider business mailing address

7393 WINNIPEG DR
DUBLIN OH
43016-8220
US

V. Phone/Fax

Practice location:
  • Phone: 614-537-1985
  • Fax: 614-873-1667
Mailing address:
  • Phone: 614-537-1985
  • Fax: 614-873-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number031144
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF0086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: