Provider Demographics
NPI:1528369527
Name:YEATTS, GARY CLAUDE (LCSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:CLAUDE
Last Name:YEATTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6885 BOARDWALK DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-9245
Mailing Address - Country:US
Mailing Address - Phone:916-797-1377
Mailing Address - Fax:
Practice Address - Street 1:1441 SECRET RAVINE PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6044
Practice Address - Country:US
Practice Address - Phone:916-202-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical