Provider Demographics
NPI:1295624864
Name:MUTAHAR, THANAA EYAD MOHAMMED
Entity type:Individual
Prefix:
First Name:THANAA
Middle Name:EYAD MOHAMMED
Last Name:MUTAHAR
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 1:2320 NW 8TH AVE APT 720
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-4291
Mailing Address - Country:US
Mailing Address - Phone:786-271-3289
Mailing Address - Fax:
Practice Address - Street 1:2320 NW 8TH AVE APT 720
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-4291
Practice Address - Country:US
Practice Address - Phone:786-271-3289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-390902103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst