Provider Demographics
NPI:1164259917
Name:YUSUF, YUSUF
Entity type:Individual
Prefix:
First Name:YUSUF
Middle Name:
Last Name:YUSUF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 HENNEPIN AVE STE 60
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3470
Mailing Address - Country:US
Mailing Address - Phone:952-400-7878
Mailing Address - Fax:
Practice Address - Street 1:2929 CHICAGO AVE APT 207
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1546
Practice Address - Country:US
Practice Address - Phone:612-471-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician