Healthcare Provider Details

I. General information

NPI: 1992100093
Provider Name (Legal Business Name): MOHAMMED BESHIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 VAN VLIET DR
GORHAM ME
04038-1200
US

IV. Provider business mailing address

20 VAN VLIET ROAD
GORHAM ME
04038-1200
US

V. Phone/Fax

Practice location:
  • Phone: 207-317-7316
  • Fax:
Mailing address:
  • Phone: 207-317-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberXL4419
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. MOHAMMED ABDALLA BESHIR
Title or Position: CONDITION CLINICAL PROF. COUNSELOR
Credential: MASTER COUNSELING
Phone: 207-317-7316