Healthcare Provider Details

I. General information

NPI: 1245946359
Provider Name (Legal Business Name): MAHMOUD YACOUB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 03/31/2024
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 LOCUST ST
PHILADELPHIA PA
19103-6305
US

IV. Provider business mailing address

801 FOREST RIDGE DR
PITTSBURGH PA
15221-4044
US

V. Phone/Fax

Practice location:
  • Phone: 330-367-7751
  • Fax:
Mailing address:
  • Phone:
  • 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: