Provider Demographics
NPI:1124569066
Name:YOUSSEF, ADRIANA MARIE (PHD, LP)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:MARIE
Last Name:YOUSSEF
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 E 24TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3959
Mailing Address - Country:US
Mailing Address - Phone:612-721-9800
Mailing Address - Fax:
Practice Address - Street 1:1315 E 24TH ST STE 1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3959
Practice Address - Country:US
Practice Address - Phone:612-721-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-11
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6098103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent