Provider Demographics
NPI:1457911968
Name:SUYAT, YVONNE ANNETTE (CADTPII ,MHACBOI)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:ANNETTE
Last Name:SUYAT
Suffix:
Gender:F
Credentials:CADTPII ,MHACBOI
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:ANNETTE
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADTPII ,MHACBOI
Mailing Address - Street 1:1630 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1436
Mailing Address - Country:US
Mailing Address - Phone:530-354-0954
Mailing Address - Fax:
Practice Address - Street 1:324 NW DAVIS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3925
Practice Address - Country:US
Practice Address - Phone:503-226-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)