Provider Demographics
NPI:1417001900
Name:MUSTAFA, NABEEH (QMHA CADC1 AA)
Entity Type:Individual
Prefix:
First Name:NABEEH
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:M
Credentials:QMHA CADC1 AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4728 NE CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-2714
Mailing Address - Country:US
Mailing Address - Phone:503-750-7765
Mailing Address - Fax:
Practice Address - Street 1:5432 N ALBINA AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2304
Practice Address - Country:US
Practice Address - Phone:503-283-3763
Practice Address - Fax:503-735-0912
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator