Provider Demographics
NPI:1316935224
Name:AL'ABSI, MUSTAFA (PH D)
Entity type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:
Last Name:AL'ABSI
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 UNIVERSITY DR
Mailing Address - Street 2:236, CENTER FOR RURAL MENTAL HEALTH STUDIES, MED.SCHOOL
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-3031
Mailing Address - Country:US
Mailing Address - Phone:218-726-7144
Mailing Address - Fax:
Practice Address - Street 1:1035 UNIVERSITY DR
Practice Address - Street 2:236, CENTER FOR RURAL MENTAL HEALTH STUDIES, MED.SCHOOL
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-3031
Practice Address - Country:US
Practice Address - Phone:218-726-7144
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4233103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN46457CEMedicare UPIN