Provider Demographics
NPI:1871669291
Name:GARY D YEAST
Entity Type:Organization
Organization Name:GARY D YEAST
Other - Org Name:MARITAL AND FAMILY THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:YEAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-842-3913
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54402-0615
Mailing Address - Country:US
Mailing Address - Phone:715-842-3913
Mailing Address - Fax:715-842-0092
Practice Address - Street 1:301 EAST KENT STREET
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403
Practice Address - Country:US
Practice Address - Phone:715-842-3913
Practice Address - Fax:715-842-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
130492OtherVALUE OPTIONS
1040872OtherCIGNA BEHAVIORAL HEALTH