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Dr. Mohammad Mehdi Momtahan, PHD
Specialist in Dallas, Georgia
NPI 1225271422

Mohammad Mehdi Momtahan is a Specialist based in Dallas, GA. Mohammad Mehdi Momtahan practices in Dallas, GA and has the professional credentials of PHD. The NPI Number for Mohammad Mehdi Momtahan is 1225271422 and holds a License No. NCC 210724 (Georgia).

The current practice location address for Mohammad Mehdi Momtahan is 59 Hillside Trace, Dallas, GA and can be reached out via phone at 770-443-1644 and via fax at 770-443-1633.

Location: 59 Hillside Trace, Dallas, GA, 30157-9476
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1225271422
Provider Name
Mohammad Mehdi Momtahan
Credential
PHD
Provider Entity Type
Individual
Gender
Male
Address
59 Hillside Trace, Dallas, GA, 30157-9476
Phone Number
770-443-1644
Fax Number
770-443-1633
Provider Enumeration Date
04/17/2009
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
59 Hillside Trace
City
Dallas
State
Georgia
Zip
30157-3315
Phone Number
770-443-1644
Fax Number
770-443-1633
person
Provider Business Mailing Address Details
Address
59 Hillside Trace
City
Dallas
State
Georgia
Zip
30157-3315
Phone Number
770-443-1644
Fax Number
770-443-1633
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
-
Taxonomy
101Y00000X
License No.
CCODP-D 0004 (Georgia)
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
ICAADC 202225 (Georgia)
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
MAC 12619 (Indiana)
Definition
Definition to come...
person
Provider's Taxonomy Details 4
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
101YP2500X
License No.
C0040 (Georgia)
Definition
Definition to come...
person
Provider's Taxonomy Details 5
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
NCC 210724 (Georgia)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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