Provider Demographics
NPI:1154494482
Name:YACOUB, NORMA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:
Last Name:YACOUB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NORMA
Other - Middle Name:
Other - Last Name:MEKHAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:20241 SW BIRCH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1782
Mailing Address - Country:US
Mailing Address - Phone:949-514-5438
Mailing Address - Fax:
Practice Address - Street 1:20241 SW BIRCH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1782
Practice Address - Country:US
Practice Address - Phone:949-514-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24329103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist