Provider Demographics
NPI:1164998811
Name:MAYER-YEAGER, ELLIOTT KURTIS
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:KURTIS
Last Name:MAYER-YEAGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 75TH ST W STE B100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8109
Mailing Address - Country:US
Mailing Address - Phone:253-345-5720
Mailing Address - Fax:
Practice Address - Street 1:12410 NYANZA RD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1447
Practice Address - Country:US
Practice Address - Phone:253-588-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician