Provider Demographics
NPI:1457115388
Name:YOUSSEF, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:YOUSSEF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50141
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-0141
Mailing Address - Country:US
Mailing Address - Phone:714-497-3130
Mailing Address - Fax:
Practice Address - Street 1:421 N BROOKHURST ST STE 119
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5618
Practice Address - Country:US
Practice Address - Phone:714-497-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist