Provider Demographics
NPI:1083329874
Name:JAMA, KAMAL
Entity Type:Individual
Prefix:
First Name:KAMAL
Middle Name:
Last Name:JAMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16255 KENYON AVE APT 130
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4815
Mailing Address - Country:US
Mailing Address - Phone:952-846-9094
Mailing Address - Fax:
Practice Address - Street 1:16255 KENYON AVE APT 130
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4815
Practice Address - Country:US
Practice Address - Phone:952-846-9094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health