Provider Demographics
NPI:1043599046
Name:YECKLEY, KEVIN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:YECKLEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28999 OLD TOWN FRONT ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5805
Mailing Address - Country:US
Mailing Address - Phone:951-834-2220
Mailing Address - Fax:
Practice Address - Street 1:27715 JEFFERSON AVE STE 112
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-6601
Practice Address - Country:US
Practice Address - Phone:951-288-6835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28954103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist