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General NPI Number Information
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NPI Number | 1255227765
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Entity Type | Individual
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Provider Name | MARIAH ABDEL-FATTAH
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Gender | Female
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 7280 S 13TH ST STE 202
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City | OAK CREEK
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State | WI
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Zip | 53154-1831
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Country | US
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Telephone | 262-251-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 W GLEN CROSSING DR
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City | OAK CREEK
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State | WI
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Zip | 53154-7477
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7493226
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License Number State | WI
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