Provider Demographics
NPI:1063729747
Name:ABDIKADIR, ILYAS A (LPCC)
Entity type:Individual
Prefix:
First Name:ILYAS
Middle Name:A
Last Name:ABDIKADIR
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 COUNTY ROAD B W STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4037
Mailing Address - Country:US
Mailing Address - Phone:612-615-6848
Mailing Address - Fax:763-201-7979
Practice Address - Street 1:1751 COUNTY ROAD B W STE 101
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4037
Practice Address - Country:US
Practice Address - Phone:612-615-6848
Practice Address - Fax:763-201-7979
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2740101YM0800X, 103TP2701X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN922503090OtherPSYCHOTHERAPY
MN843569697OtherHOME HEALTH CARE