Provider Demographics
NPI:1083967673
Name:YUSSUF, BISHARO JAAMAC (LPCC)
Entity Type:Individual
Prefix:
First Name:BISHARO
Middle Name:JAAMAC
Last Name:YUSSUF
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:BISHARO
Other - Middle Name:OSMAN
Other - Last Name:GARDAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1910 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3426
Mailing Address - Country:US
Mailing Address - Phone:612-242-7843
Mailing Address - Fax:
Practice Address - Street 1:621 E 38TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2571
Practice Address - Country:US
Practice Address - Phone:612-703-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health