Provider Demographics
NPI:1164661237
Name:HASSAN, MAHMOUD S (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:S
Last Name:HASSAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 N DALE MABRY HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1580
Mailing Address - Country:US
Mailing Address - Phone:813-933-2100
Mailing Address - Fax:813-933-2100
Practice Address - Street 1:8910 N DALE MABRY HWY STE 2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1580
Practice Address - Country:US
Practice Address - Phone:813-933-2100
Practice Address - Fax:813-933-2100
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9342101YP2500X
FLMH9342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009248200Medicaid