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General NPI Number Information
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NPI Number | 1427567684
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Entity Type | Individual
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Provider Name | ALI ADIL AL-HUMADI PSYD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 933 WAUBE LN
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City | GREEN BAY
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State | WI
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Zip | 54304-5521
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Country | US
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Telephone | 920-548-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 1162 BROOKWOOD DR APT 209
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City | GREEN BAY
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State | WI
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Zip | 54304-4140
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Country | US
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Telephone | 716-307-9403
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5344-57
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License Number State | WI
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