Healthcare Provider Details

I. General information

NPI: 1427567684
Provider Name (Legal Business Name): ALI ADIL AL-HUMADI PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 WAUBE LN
GREEN BAY WI
54304-5521
US

IV. Provider business mailing address

1162 BROOKWOOD DR APT 209
GREEN BAY WI
54304-4140
US

V. Phone/Fax

Practice location:
  • Phone: 920-548-9500
  • Fax:
Mailing address:
  • Phone: 716-307-9403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5344-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: