Provider Demographics
NPI:1942819339
Name:MOHAMOUD, FARHAN AHMED
Entity Type:Individual
Prefix:
First Name:FARHAN
Middle Name:AHMED
Last Name:MOHAMOUD
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 1:9201 NICOLLET AVE S APT 221
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-3767
Mailing Address - Country:US
Mailing Address - Phone:507-382-1014
Mailing Address - Fax:
Practice Address - Street 1:9201 NICOLLET AVE S APT 221
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3767
Practice Address - Country:US
Practice Address - Phone:507-382-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician