Provider Demographics
NPI:1376801571
Name:HUSSEN, KASSIM AHMED (COUNESLOR)
Entity Type:Individual
Prefix:MR
First Name:KASSIM
Middle Name:AHMED
Last Name:HUSSEN
Suffix:
Gender:M
Credentials:COUNESLOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 S LA BREA AVE
Mailing Address - Street 2:SUITE # A
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-3891
Mailing Address - Country:US
Mailing Address - Phone:310-256-4870
Mailing Address - Fax:310-677-2741
Practice Address - Street 1:1210 S LA BREA AVE
Practice Address - Street 2:SUITE # A
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3891
Practice Address - Country:US
Practice Address - Phone:310-256-4870
Practice Address - Fax:310-677-2741
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1900633AN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)