Provider Demographics
NPI:1164180162
Name:AL HASSAN, EMAN HUSEIN
Entity Type:Individual
Prefix:MS
First Name:EMAN
Middle Name:HUSEIN
Last Name:AL HASSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 CYPRESS MILL RD APT S8
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-7954
Mailing Address - Country:US
Mailing Address - Phone:256-335-9743
Mailing Address - Fax:
Practice Address - Street 1:2314 6TH AVE SE STE D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6565
Practice Address - Country:US
Practice Address - Phone:256-686-3169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-194961106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician