Provider Demographics
NPI:1083389704
Name:MOALIN, AHMED LIBAN
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:LIBAN
Last Name:MOALIN
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 1:2208 E 117TH ST
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1265
Mailing Address - Country:US
Mailing Address - Phone:952-236-7880
Mailing Address - Fax:
Practice Address - Street 1:2208 E 117TH ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1265
Practice Address - Country:US
Practice Address - Phone:952-236-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst