Healthcare Provider Details

I. General information

NPI: 1003681685
Provider Name (Legal Business Name): AMAR DEEQ YUSSUF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2023
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 AMERICAN BLVD E STE 19
BLOOMINGTON MN
55425-1401
US

IV. Provider business mailing address

1701 AMERICAN BLVD E STE 19
BLOOMINGTON MN
55425-1401
US

V. Phone/Fax

Practice location:
  • Phone: 952-212-0358
  • Fax:
Mailing address:
  • Phone: 952-212-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: