Healthcare Provider Details

I. General information

NPI: 1487482642
Provider Name (Legal Business Name): YOUSSEF NAKHLA PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8146 GREENBACK LN STE 202B
FAIR OAKS CA
95628-2540
US

IV. Provider business mailing address

705 E BIDWELL ST STE 2-288
FOLSOM CA
95630-3315
US

V. Phone/Fax

Practice location:
  • Phone: 916-360-0075
  • Fax:
Mailing address:
  • Phone: 916-360-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: