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General NPI Number Information
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NPI Number | 1154917367
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Entity Type | Individual
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Provider Name | FARYAL KHAN MS
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Gender | Female
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Dates
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Enumeration Date | 12/12/2020
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Last Update Date | 12/12/2020
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Provider Practice Location Address
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Address Line | 3900 JACKSON ST NE STE 30
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City | COLUMBIA HEIGHTS
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State | MN
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Zip | 55421-3985
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Country | US
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Telephone | 612-504-1318
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Fax |
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Provider Business Mailing Address
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Address Line | 2474 SCHNEIDER CT
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City | CHASKA
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State | MN
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Zip | 55318-4539
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Country | US
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Telephone | 952-451-5229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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