Provider Demographics
NPI:1740887652
Name:HOUFANEH, ABDULLAHI
Entity type:Individual
Prefix:
First Name:ABDULLAHI
Middle Name:
Last Name:HOUFANEH
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 1:2104 PARK AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-6615
Mailing Address - Country:US
Mailing Address - Phone:612-986-3923
Mailing Address - Fax:612-293-7639
Practice Address - Street 1:2104 PARK AVE STE 111
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-6615
Practice Address - Country:US
Practice Address - Phone:612-986-3923
Practice Address - Fax:612-293-7639
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician