Provider Demographics
NPI:1356981450
Name:AL-ANSARI, JOWAD (PSY D)
Entity type:Individual
Prefix:
First Name:JOWAD
Middle Name:
Last Name:AL-ANSARI
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30700 TELEGRAPH RD STE 1645
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4525
Mailing Address - Country:US
Mailing Address - Phone:248-283-1100
Mailing Address - Fax:248-283-1103
Practice Address - Street 1:30700 TELEGRAPH RD STE 1645
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4525
Practice Address - Country:US
Practice Address - Phone:248-283-1100
Practice Address - Fax:248-283-1103
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling