Provider Demographics
NPI:1083818124
Name:AYYOUB, LAILA JOSEPHINE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:JOSEPHINE
Last Name:AYYOUB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAILA
Other - Middle Name:JOSEPHINE AYYOUB
Other - Last Name:CUSICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3085 NW DEER RUN ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3104
Mailing Address - Country:US
Mailing Address - Phone:541-760-0777
Mailing Address - Fax:
Practice Address - Street 1:3085 NW DEER RUN ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3104
Practice Address - Country:US
Practice Address - Phone:541-760-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL45581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical