Provider Demographics
NPI:1548865918
Name:JIBRELL, ABDULHAMID HASSAN
Entity type:Individual
Prefix:
First Name:ABDULHAMID
Middle Name:HASSAN
Last Name:JIBRELL
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 1:1252 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 1:1252 MOORE LAKE DR E
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5170
Practice Address - Country:US
Practice Address - Phone:763-227-9957
Practice Address - Fax:612-345-4586
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health