Provider Demographics
NPI:1346833787
Name:KHAN, MOHAMMAD A (LLMSW)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19109 PINE LEDGE DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7588
Mailing Address - Country:US
Mailing Address - Phone:734-925-4140
Mailing Address - Fax:734-519-5517
Practice Address - Street 1:20600 EUREKA RD STE 707
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5376
Practice Address - Country:US
Practice Address - Phone:734-925-4140
Practice Address - Fax:734-519-5517
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health