Healthcare Provider Details

I. General information

NPI: 1760329452
Provider Name (Legal Business Name): TAFAZZUL HUSSAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21751 W 11 MILE RD STE 205
SOUTHFIELD MI
48076-3712
US

IV. Provider business mailing address

13425 DENVER CIR S
STERLING HEIGHTS MI
48312-1634
US

V. Phone/Fax

Practice location:
  • Phone: 248-301-1080
  • Fax:
Mailing address:
  • Phone: 631-923-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6851121555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: