Provider Demographics
NPI:1386311827
Name:ALQAHTANI, HUSSAIN
Entity type:Individual
Prefix:
First Name:HUSSAIN
Middle Name:
Last Name:ALQAHTANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 RIVER RD, SPENCER, IN, US
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460
Mailing Address - Country:US
Mailing Address - Phone:812-369-9875
Mailing Address - Fax:
Practice Address - Street 1:1455 RIVER RD, SPENCER, IN, US
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-4746
Practice Address - Country:US
Practice Address - Phone:812-369-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-51239101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor