Provider Demographics
NPI:1528778883
Name:BELKACEM, YOUSRA
Entity type:Individual
Prefix:
First Name:YOUSRA
Middle Name:
Last Name:BELKACEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15020 LAKE MAGDALENE BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1702
Mailing Address - Country:US
Mailing Address - Phone:813-516-7994
Mailing Address - Fax:
Practice Address - Street 1:15020 LAKE MAGDALENE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1702
Practice Address - Country:US
Practice Address - Phone:813-516-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB422-960-93-644-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician