Basic Information
| Provider Information | |||||||||
| NPI: | 1356981450 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AL-ANSARI | ||||||||
| FirstName: | JOWAD | ||||||||
| MiddleName: | |||||||||
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| Credential: | PSY. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30700 TELEGRAPH RD STE 1645 | ||||||||
| Address2: | |||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482831100 | ||||||||
| FaxNumber: | 2482831103 | ||||||||
| Practice Location | |||||||||
| Address1: | 30700 TELEGRAPH RD STE 1645 | ||||||||
| Address2: | |||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482831100 | ||||||||
| FaxNumber: | 2482831103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2020 | ||||||||
| LastUpdateDate: | 01/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.