Provider Demographics
NPI:1366782914
Name:ABDULLAH, IMAN (LPC)
Entity type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:ABDULLAH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 S RURAL RD STE 111
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3717
Mailing Address - Country:US
Mailing Address - Phone:480-382-0038
Mailing Address - Fax:
Practice Address - Street 1:6625 S RURAL RD STE 111
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3717
Practice Address - Country:US
Practice Address - Phone:517-346-9568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional