Healthcare Provider Details

I. General information

NPI: 1063950137
Provider Name (Legal Business Name): CHANEL YOUSIF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37483 GRANTLAND ST
LIVONIA MI
48150-1021
US

IV. Provider business mailing address

37483 GRANTLAND ST
LIVONIA MI
48150-1021
US

V. Phone/Fax

Practice location:
  • Phone: 313-953-9682
  • Fax:
Mailing address:
  • Phone: 313-953-9682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401226513
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: