Provider Demographics
NPI:1720170558
Name:YOUSIF, GLORIA (LLP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:YOUSIF
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:MANSOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:6826 TORYBROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6826 TORYBROOKE CIR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2165
Practice Address - Country:US
Practice Address - Phone:248-276-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy