Provider Demographics
NPI:1164858916
Name:YARRITU, DOMINIQUE MICHELE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:MICHELE
Last Name:YARRITU
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 S BASCOM AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3535
Mailing Address - Country:US
Mailing Address - Phone:408-800-3958
Mailing Address - Fax:
Practice Address - Street 1:1210 S BASCOM AVE STE 114
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3535
Practice Address - Country:US
Practice Address - Phone:408-800-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist