Provider Demographics
NPI:1154917367
Name:KHAN, FARYAL (MS)
Entity type:Individual
Prefix:
First Name:FARYAL
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 SCHNEIDER CT
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-4539
Mailing Address - Country:US
Mailing Address - Phone:952-451-5229
Mailing Address - Fax:
Practice Address - Street 1:3900 JACKSON ST NE STE 30
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3985
Practice Address - Country:US
Practice Address - Phone:612-504-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist