=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760723670
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. BASSEL FOUAD HELMI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2013
-----------------------------------------------------
Last Update Date | 03/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4510 PLANK RD STE 100 ELITE ACADEMY
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22407-0138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-412-5028
-----------------------------------------------------
Fax | 540-412-5030
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4510 PLANK ROAD, STE. 100, BOX 5 ELITE ACADEMY
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22407-0138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-412-5028
-----------------------------------------------------
Fax | 540-412-5030
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------