Provider Demographics
NPI:1346446606
Name:THRUSH, YVETTE DIANE
Entity Type:Individual
Prefix:MS
First Name:YVETTE
Middle Name:DIANE
Last Name:THRUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:YVETTE
Other - Middle Name:DIANE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:1322 N AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2639
Mailing Address - Country:US
Mailing Address - Phone:310-513-1300
Mailing Address - Fax:
Practice Address - Street 1:1322 N AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2639
Practice Address - Country:US
Practice Address - Phone:310-513-1300
Practice Address - Fax:310-513-1311
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor