Provider Demographics
NPI:1831989151
Name:ABOKOR, ISMAIL IBRAAHIM
Entity type:Individual
Prefix:
First Name:ISMAIL
Middle Name:IBRAAHIM
Last Name:ABOKOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 MOORE LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5170
Mailing Address - Country:US
Mailing Address - Phone:763-227-9957
Mailing Address - Fax:612-345-4586
Practice Address - Street 1:12525 EAST MOORE LAKE DR
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-227-9952
Practice Address - Fax:612-345-4585
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor