Provider Demographics
NPI:1306636915
Name:MOHAMED, MARIAN ALI
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:ALI
Last Name:MOHAMED
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 1:9900 13TH AVE N STE 210E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-5070
Mailing Address - Country:US
Mailing Address - Phone:612-426-8785
Mailing Address - Fax:
Practice Address - Street 1:9900 13TH AVE N STE 210E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-5070
Practice Address - Country:US
Practice Address - Phone:612-426-8785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician