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General NPI Number Information
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NPI Number | 1992100093
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Entity Type | Organization
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Legal Business Name | MOHAMMED BESHIR
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 20 VAN VLIET DR
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City | GORHAM
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State | ME
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Zip | 04038-1200
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Country | US
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Telephone | 207-317-7316
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Fax |
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Provider Business Mailing Address
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Address Line | 20 VAN VLIET ROAD
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City | GORHAM
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State | ME
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Zip | 04038-1200
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Country | US
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Telephone | 207-317-7316
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Fax |
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Authorized Official
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Title or Position | CONDITION CLINICAL PROF. COUNSELOR
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Name | MR. MOHAMMED ABDALLA BESHIR
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Credential | MASTER COUNSELING
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Telephone | 207-317-7316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | XL4419
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License Number State | ME
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