Provider Demographics
NPI:1962835165
Name:YATES, ANTHONY LEE (CSAC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LEE
Last Name:YATES
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:KURTISTOWN
Mailing Address - State:HI
Mailing Address - Zip Code:96760-0711
Mailing Address - Country:US
Mailing Address - Phone:808-936-4382
Mailing Address - Fax:
Practice Address - Street 1:16-759 WAO KELE ST.
Practice Address - Street 2:
Practice Address - City:KURTISTOWN
Practice Address - State:HI
Practice Address - Zip Code:96760-0711
Practice Address - Country:US
Practice Address - Phone:808-936-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1657-11101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)