Healthcare Provider Details

I. General information

NPI: 1336890532
Provider Name (Legal Business Name): ABSTAIN COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8330 N 19TH AVE APT 3083
PHOENIX AZ
85021-5281
US

IV. Provider business mailing address

8330 N 19TH AVE APT 3083
PHOENIX AZ
85021-5281
US

V. Phone/Fax

Practice location:
  • Phone: 239-745-2517
  • Fax:
Mailing address:
  • Phone: 239-745-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MUHAMMAD NAEEM
Title or Position: MANAGER CREDENTIALING
Credential:
Phone: 720-446-6888