Provider Demographics
NPI:1083111389
Name:SABA GHAZIMOGHADAM, PH.D., LP, LLC
Entity Type:Organization
Organization Name:SABA GHAZIMOGHADAM, PH.D., LP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SABA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZIMOGHADAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-308-3623
Mailing Address - Street 1:6582 WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:MINNETRISTA
Mailing Address - State:MN
Mailing Address - Zip Code:55364-8630
Mailing Address - Country:US
Mailing Address - Phone:612-308-3623
Mailing Address - Fax:
Practice Address - Street 1:6582 WILLOW CT
Practice Address - Street 2:
Practice Address - City:MINNETRISTA
Practice Address - State:MN
Practice Address - Zip Code:55364-8630
Practice Address - Country:US
Practice Address - Phone:612-308-3623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5561261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health