Provider Demographics
NPI:1033865696
Name:IMHOF, YAMELIS PRIETO (RBT)
Entity Type:Individual
Prefix:
First Name:YAMELIS
Middle Name:PRIETO
Last Name:IMHOF
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7028 W WATERS AVE # 295
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2292
Mailing Address - Country:US
Mailing Address - Phone:813-842-6934
Mailing Address - Fax:
Practice Address - Street 1:3802 EHRLICH RD STE 310
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2355
Practice Address - Country:US
Practice Address - Phone:813-418-9038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-204082106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician