Provider Demographics
NPI:1265009625
Name:YEVSEYEVA, LYUBOV G
Entity Type:Individual
Prefix:MISS
First Name:LYUBOV
Middle Name:G
Last Name:YEVSEYEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LUBY
Other - Middle Name:G
Other - Last Name:YEVSEYEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BEHAVIORAL THERAPIST
Mailing Address - Street 1:101 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5203
Practice Address - Country:US
Practice Address - Phone:916-709-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other