Provider Demographics
NPI:1154157741
Name:IBRAHIM, HANI HASSAN
Entity type:Individual
Prefix:
First Name:HANI
Middle Name:HASSAN
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3717
Mailing Address - Country:US
Mailing Address - Phone:763-213-3551
Mailing Address - Fax:
Practice Address - Street 1:2625 E FRANKLIN AVE STE LL4
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1195
Practice Address - Country:US
Practice Address - Phone:763-213-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health