Provider Demographics
NPI:1578327136
Name:KAMBAKHSH, MINA
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:KAMBAKHSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 MULHOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4356
Mailing Address - Country:US
Mailing Address - Phone:248-877-6462
Mailing Address - Fax:
Practice Address - Street 1:2300 WASHTENAW AVE STE 100
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4500
Practice Address - Country:US
Practice Address - Phone:734-585-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical