Provider Demographics
NPI:1467980185
Name:YANG, BAO (MA)
Entity Type:Individual
Prefix:
First Name:BAO
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S CHESTNUT AVE # 14
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-4709
Mailing Address - Country:US
Mailing Address - Phone:559-453-8050
Mailing Address - Fax:
Practice Address - Street 1:4812 E BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-5014
Practice Address - Country:US
Practice Address - Phone:559-453-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist