MEDICARE: MINA YOUSSEF PSYCHOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	36782	CA
2	1041C0700X	Clinical Social Worker	95025	CA

General Provider Information

NPI Number	:	1316562390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA YOUSSEF PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	4280 LATHAM ST STE G
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92501-1737
Country	:	US
Telephone Number	:	909-235-5662
Fax Number	:	909-235-6019

Provider Business Practice Location Address
First Line	:	3333 CONCOURS STE 8102
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-5522
Country	:	US
Telephone Number	:	909-295-5805
Fax Number	:	909-235-6019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	06/02/2026

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