Healthcare Provider Details

I. General information

NPI: 1326423393
Provider Name (Legal Business Name): BESRAT MUSSA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 10TH ST STE 811
MODESTO CA
95354-2305
US

IV. Provider business mailing address

931 10TH ST STE 811
MODESTO CA
95354-2305
US

V. Phone/Fax

Practice location:
  • Phone: 209-661-5576
  • Fax:
Mailing address:
  • Phone: 209-661-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number67939
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number92527
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number92527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: