Provider Demographics
NPI:1477701035
Name:YELLIN, JAIMEE LAUREN
Entity Type:Individual
Prefix:
First Name:JAIMEE
Middle Name:LAUREN
Last Name:YELLIN
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 1:4160 GRAND VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5214
Mailing Address - Country:US
Mailing Address - Phone:310-751-1107
Mailing Address - Fax:310-397-5827
Practice Address - Street 1:4160 GRAND VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5214
Practice Address - Country:US
Practice Address - Phone:310-751-1107
Practice Address - Fax:310-397-5827
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29683104100000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)