Provider Demographics
NPI:1205571114
Name:IBNOUF, NAZAR A
Entity type:Individual
Prefix:
First Name:NAZAR
Middle Name:A
Last Name:IBNOUF
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 1:3800 SW CEDAR HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2027
Mailing Address - Country:US
Mailing Address - Phone:503-924-2448
Mailing Address - Fax:
Practice Address - Street 1:3800 SW CEDAR HILLS BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2027
Practice Address - Country:US
Practice Address - Phone:503-924-2448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health