Provider Demographics
NPI:1558428946
Name:AHLIJAH, KOFFI WOLALI (PLMHP)
Entity Type:Individual
Prefix:MR
First Name:KOFFI
Middle Name:WOLALI
Last Name:AHLIJAH
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 N 113TH PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11711 ARBOR ST
Practice Address - Street 2:STE 110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2975
Practice Address - Country:US
Practice Address - Phone:402-392-2972
Practice Address - Fax:402-392-2978
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7563101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health