Healthcare Provider Details

I. General information

NPI: 1154237642
Provider Name (Legal Business Name): HASSAN O MOHAMED T-26-6876
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5714 SE POWELL BLVD STE 202
PORTLAND OR
97206-2856
US

IV. Provider business mailing address

5714 SE POWELL BLVD STE 202
PORTLAND OR
97206-2856
US

V. Phone/Fax

Practice location:
  • Phone: 971-484-6848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-26-6876
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: