Provider Demographics
NPI:1508589839
Name:ASIM, MUJAHID
Entity Type:Individual
Prefix:
First Name:MUJAHID
Middle Name:
Last Name:ASIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16165 N 83RD AVE STE 224
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5818
Mailing Address - Country:US
Mailing Address - Phone:215-501-4332
Mailing Address - Fax:
Practice Address - Street 1:16165 N 83RD AVE STE 224
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5818
Practice Address - Country:US
Practice Address - Phone:215-501-4332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)