Provider Demographics
NPI:1306862214
Name:YANKAUER, MARK (MFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:YANKAUER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6775
Mailing Address - Country:US
Mailing Address - Phone:916-929-4487
Mailing Address - Fax:916-927-0126
Practice Address - Street 1:601 UNIVERSITY AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6775
Practice Address - Country:US
Practice Address - Phone:916-929-4487
Practice Address - Fax:916-927-0126
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 29810106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 29810OtherSTATE MFT LICENSE NO.