Provider Demographics
NPI:1366817462
Name:YUROS, NITA
Entity Type:Individual
Prefix:
First Name:NITA
Middle Name:
Last Name:YUROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4618
Mailing Address - Country:US
Mailing Address - Phone:360-953-3559
Mailing Address - Fax:
Practice Address - Street 1:318 E MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-8508
Practice Address - Country:US
Practice Address - Phone:360-953-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG 60179315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health