Provider Demographics
NPI:1922730357
Name:SB YAB CO.
Entity Type:Organization
Organization Name:SB YAB CO.
Other - Org Name:SLC PSYCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:YABKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:385-355-1018
Mailing Address - Street 1:699 E SOUTH TEMPLE STE 300A
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1188
Mailing Address - Country:US
Mailing Address - Phone:661-312-9335
Mailing Address - Fax:
Practice Address - Street 1:699 E SOUTH TEMPLE STE 300A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1188
Practice Address - Country:US
Practice Address - Phone:385-355-1018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty