Provider Demographics
NPI:1689247678
Name:SALAAM, TALIB NASIR (QMHP)
Entity Type:Individual
Prefix:MR
First Name:TALIB
Middle Name:NASIR
Last Name:SALAAM
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3359 LAWN AVE APT C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1112
Mailing Address - Country:US
Mailing Address - Phone:314-610-1071
Mailing Address - Fax:
Practice Address - Street 1:3359 LAWN AVE APT C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1112
Practice Address - Country:US
Practice Address - Phone:314-610-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor