Provider Demographics
NPI:1629086301
Name:YATES, WILLIAM S (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:YATES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14815 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3708
Mailing Address - Country:US
Mailing Address - Phone:210-494-1991
Mailing Address - Fax:210-494-7575
Practice Address - Street 1:14815 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3708
Practice Address - Country:US
Practice Address - Phone:210-494-1991
Practice Address - Fax:210-494-7575
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23587103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742534224OtherTAX ID
TX009513602Medicaid
TX009513602Medicaid