Provider Demographics
NPI:1720307135
Name:ALI, MUHAMMAD (CASE MANAGER)
Entity Type:Individual
Prefix:MR
First Name:MUHAMMAD
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5326 NW ELM AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4622
Mailing Address - Country:US
Mailing Address - Phone:580-574-0580
Mailing Address - Fax:
Practice Address - Street 1:5326 NW ELM AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4622
Practice Address - Country:US
Practice Address - Phone:580-574-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22450101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)