Provider Demographics
NPI:1720307903
Name:FAHOUM, YOUSEF ARFAN (DRPH, MA, LPE-I)
Entity Type:Individual
Prefix:DR
First Name:YOUSEF
Middle Name:ARFAN
Last Name:FAHOUM
Suffix:
Gender:M
Credentials:DRPH, MA, LPE-I
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 241967
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0037
Mailing Address - Country:US
Mailing Address - Phone:501-238-6560
Mailing Address - Fax:501-904-4452
Practice Address - Street 1:2215 WILDWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120
Practice Address - Country:US
Practice Address - Phone:501-238-6560
Practice Address - Fax:501-904-4452
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12-01E103K00000X, 103T00000X, 103TB0200X, 103TC0700X, 103TC1900X, 103TP2701X, 103TR0400X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation