Provider Demographics
NPI:1407394190
Name:HUSSEINI, MIKE
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:HUSSEINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 MONTEZUMA ST
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571-1622
Mailing Address - Country:US
Mailing Address - Phone:707-374-5243
Mailing Address - Fax:
Practice Address - Street 1:628 MONTEZUMA ST
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571-1622
Practice Address - Country:US
Practice Address - Phone:707-374-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295880821OtherCOMMUNITY/BEHAVIORAL HEALTH