Provider Demographics
NPI:1790296242
Name:YUSUF, LIIBAN AHMED (LMHC)
Entity Type:Individual
Prefix:MR
First Name:LIIBAN
Middle Name:AHMED
Last Name:YUSUF
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 SW TRENTON ST UNIT 47083
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3951
Mailing Address - Country:US
Mailing Address - Phone:206-218-4942
Mailing Address - Fax:
Practice Address - Street 1:6008 HIGH POINT DR SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3118
Practice Address - Country:US
Practice Address - Phone:206-218-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60639896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2125064Medicaid