Provider Demographics
NPI:1609975168
Name:YOUSSEF, GARY F (MS, MFT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:F
Last Name:YOUSSEF
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 KEARNY VILLA RD APT 445
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1991
Mailing Address - Country:US
Mailing Address - Phone:858-431-6066
Mailing Address - Fax:
Practice Address - Street 1:3455 KEARNY VILLA RD APT 445
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1991
Practice Address - Country:US
Practice Address - Phone:858-431-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45456106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609975168Medicaid
CA45979OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES
CA45456OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES