Provider Demographics
NPI:1023364403
Name:Y TEAM
Entity Type:Organization
Organization Name:Y TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRAINEE
Authorized Official - Prefix:
Authorized Official - First Name:KIRAA
Authorized Official - Middle Name:EYVONE
Authorized Official - Last Name:LILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-927-7219
Mailing Address - Street 1:1174 REGENT ST
Mailing Address - Street 2:APT E
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5359
Mailing Address - Country:US
Mailing Address - Phone:510-927-7219
Mailing Address - Fax:
Practice Address - Street 1:4175 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5774
Practice Address - Country:US
Practice Address - Phone:510-262-6551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty