Provider Demographics
NPI:1477137461
Name:FARAH, AYANLE ADEN
Entity Type:Individual
Prefix:
First Name:AYANLE
Middle Name:ADEN
Last Name:FARAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ABDI
Other - Middle Name:MOHAMED
Other - Last Name:JAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE 131
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2849
Mailing Address - Country:US
Mailing Address - Phone:651-528-7242
Mailing Address - Fax:651-666-1211
Practice Address - Street 1:1821 UNIVERSITY AVE W STE 131
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2849
Practice Address - Country:US
Practice Address - Phone:651-528-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities