Healthcare Provider Details

I. General information

NPI: 1164661237
Provider Name (Legal Business Name): MAHMOUD S HASSAN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9323 MANDRAKE CT
TAMPA FL
33647-3290
US

IV. Provider business mailing address

PO BOX 270098
TAMPA FL
33688-0098
US

V. Phone/Fax

Practice location:
  • Phone: 813-766-2536
  • Fax: 813-933-2103
Mailing address:
  • Phone: 813-389-3930
  • Fax: 813-933-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH 9342
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: