Provider Demographics
NPI:1215364757
Name:NAHMAD-FAITH, ETHEL (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:
Last Name:NAHMAD-FAITH
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 XERXES AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2255
Mailing Address - Country:US
Mailing Address - Phone:612-384-5602
Mailing Address - Fax:
Practice Address - Street 1:2 E FRANKLIN AVE STE 1A
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2557
Practice Address - Country:US
Practice Address - Phone:612-384-5602
Practice Address - Fax:612-465-4567
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2388106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1518053834Medicaid