Provider Demographics
NPI:1417222092
Name:YATES, RICHARD I (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:I
Last Name:YATES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 ENGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2042
Mailing Address - Country:US
Mailing Address - Phone:216-291-2512
Mailing Address - Fax:
Practice Address - Street 1:852 ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2042
Practice Address - Country:US
Practice Address - Phone:216-291-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0000113 SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional