Provider Demographics
NPI:1689494452
Name:MIRE, AS HAR MUSA
Entity type:Individual
Prefix:
First Name:AS HAR
Middle Name:MUSA
Last Name:MIRE
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 1:2614 NICOLLET AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1628
Mailing Address - Country:US
Mailing Address - Phone:612-453-6527
Mailing Address - Fax:
Practice Address - Street 1:2614 NICOLLET AVE STE 208
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1628
Practice Address - Country:US
Practice Address - Phone:612-453-6527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician