Individual
LIBAN JAMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
4312 SHADY OAK RD S APT 217, MINNETONKA, MN 55343-6932
(612) 978-8046
Mailing address
4312 SHADY OAK RD S APT 217, MINNETONKA, MN 55343-6932
(612) 978-8046
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
MN
Other
Enumeration date
07/14/2025
Last updated
07/14/2025
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