Provider Demographics
NPI:1346500535
Name:YORKE, JEVAUGHN ANTHONY
Entity Type:Individual
Prefix:MR
First Name:JEVAUGHN
Middle Name:ANTHONY
Last Name:YORKE
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 1:635 N CHIPPEWA AVE
Mailing Address - Street 2:APT 27
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4453
Mailing Address - Country:US
Mailing Address - Phone:323-691-8160
Mailing Address - Fax:
Practice Address - Street 1:1503 S COAST DR
Practice Address - Street 2:STE 202
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1534
Practice Address - Country:US
Practice Address - Phone:949-515-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist