Provider Demographics
NPI:1255932109
Name:YANES, OSCAR GUILLERMO (MA)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:GUILLERMO
Last Name:YANES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N HAMMES AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8139
Mailing Address - Country:US
Mailing Address - Phone:708-691-0155
Mailing Address - Fax:
Practice Address - Street 1:210 N HAMMES AVE STE 204
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8139
Practice Address - Country:US
Practice Address - Phone:708-691-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional