Provider Demographics
NPI:1730542226
Name:ASSAD, MAHMOUD RIYAD (LPCC)
Entity type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:RIYAD
Last Name:ASSAD
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 EMERALD PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6236
Mailing Address - Country:US
Mailing Address - Phone:614-689-3419
Mailing Address - Fax:
Practice Address - Street 1:6500 EMERALD PKWY STE 100
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-6236
Practice Address - Country:US
Practice Address - Phone:614-689-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1400594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871101Medicaid