Provider Demographics
NPI:1407353352
Name:MOHAMED, MUNA ALI (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:MUNA
Middle Name:ALI
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 MARSHALL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6345
Mailing Address - Country:US
Mailing Address - Phone:651-689-3487
Mailing Address - Fax:
Practice Address - Street 1:1437 MARSHALL AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6345
Practice Address - Country:US
Practice Address - Phone:612-532-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health