Provider Demographics
NPI:1497005078
Name:YETTER, BROOKE (MA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:YETTER
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 1:3812 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2413
Mailing Address - Country:US
Mailing Address - Phone:310-373-6359
Mailing Address - Fax:
Practice Address - Street 1:3812 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 520
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2413
Practice Address - Country:US
Practice Address - Phone:310-373-6359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health