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General NPI Number Information
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NPI Number | 1508053273
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Entity Type | Organization
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Legal Business Name | CLINICAL PSYCHOPHARMACOLOGY CONSULTANTS, PA
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 3601 PARK CENTER BLVD SUITE 207
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2531
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Country | US
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Telephone | 952-926-3364
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Fax | 952-926-3369
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Provider Business Mailing Address
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Address Line | 3601 PARK CENTER BLVD SUITE 207
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2531
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Country | US
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Telephone | 952-926-3364
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Fax | 952-926-3369
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. FARUK SAID ABUZZAHAB SR.
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Credential | MD, PHD
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Telephone | 952-926-3364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 17068
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License Number State | MN
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