Provider Demographics
NPI:1164942009
Name:FATIMA KHAN ALI CONSULTANT LLC
Entity Type:Organization
Organization Name:FATIMA KHAN ALI CONSULTANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN-ALI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:954-937-5804
Mailing Address - Street 1:2144 SW 101ST WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6522
Mailing Address - Country:US
Mailing Address - Phone:954-937-5804
Mailing Address - Fax:
Practice Address - Street 1:8050 N UNIVERSITY DR STE 201
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2102
Practice Address - Country:US
Practice Address - Phone:954-532-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3003261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)