Provider Demographics
NPI:1477630788
Name:YATES, DAVID (MFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:YATES
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1561
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-1561
Mailing Address - Country:US
Mailing Address - Phone:530-676-0223
Mailing Address - Fax:530-622-2793
Practice Address - Street 1:3343 EASTVIEW DR
Practice Address - Street 2:
Practice Address - City:SHINGLE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95682-9531
Practice Address - Country:US
Practice Address - Phone:530-676-0223
Practice Address - Fax:530-622-2793
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC16705106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist