Basic Information
| Provider Information | |||||||||
| NPI: | 1720170558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUSIF | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MANSOUR | ||||||||
| OtherFirstName: | GLORIA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MA, LLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6826 TORYBROOKE CIR | ||||||||
| Address2: | |||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483232165 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6826 TORYBROOKE CIR | ||||||||
| Address2: | |||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483232165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482768000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 05/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TP2701X | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.