Provider Demographics
NPI:1538734132
Name:BARSOUM, ISABELLE FAHMI SR (AMFT)
Entity type:Individual
Prefix:MS
First Name:ISABELLE
Middle Name:FAHMI
Last Name:BARSOUM
Suffix:SR
Gender:F
Credentials:AMFT
Other - Prefix:MS
Other - First Name:ISABELLE
Other - Middle Name:FAHMI
Other - Last Name:BARSOUM
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:AMFT
Mailing Address - Street 1:11800 CHINO AVE. STE. # 125
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-517-2020
Mailing Address - Fax:909-517-2022
Practice Address - Street 1:11800 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-7200
Practice Address - Country:US
Practice Address - Phone:909-517-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125213101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor