Provider Demographics
NPI:1649320888
Name:MAHMOOD, HUMERA (IMFT, LCDCIII)
Entity type:Individual
Prefix:MRS
First Name:HUMERA
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:IMFT, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7393 WINNIPEG DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8220
Mailing Address - Country:US
Mailing Address - Phone:614-537-1985
Mailing Address - Fax:614-873-1667
Practice Address - Street 1:97 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9301
Practice Address - Country:US
Practice Address - Phone:614-537-1985
Practice Address - Fax:614-873-1667
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031144101YA0400X
OHF0086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)