Individual
JASMINE KOUSSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
127 N LAFAYETTE ST, SOUTH LYON, MI 48178-1210
(248) 573-7417
Mailing address
47818 VAN DYKE AVE, SHELBY TWP, MI 48317-3373
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6451023614
MI
104100000X
Social Worker
Primary
0000000000
MI
Other
Enumeration date
01/23/2024
Last updated
05/13/2026
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