Provider Demographics
NPI:1164060539
Name:YUTH, ADELE MARIE (LASAC)
Entity Type:Individual
Prefix:MS
First Name:ADELE
Middle Name:MARIE
Last Name:YUTH
Suffix:
Gender:F
Credentials:LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2748
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92546-2748
Mailing Address - Country:US
Mailing Address - Phone:951-708-4019
Mailing Address - Fax:951-767-9820
Practice Address - Street 1:39990 FAURE RD
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-9408
Practice Address - Country:US
Practice Address - Phone:951-708-4019
Practice Address - Fax:951-767-9820
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15190101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)