Provider Demographics
NPI:1639998669
Name:MAYA YUTSIS, PHD, A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:MAYA YUTSIS, PHD, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUTSIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-827-5699
Mailing Address - Street 1:15100 LOS GATOS BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2028
Mailing Address - Country:US
Mailing Address - Phone:408-827-5699
Mailing Address - Fax:855-557-8583
Practice Address - Street 1:15100 LOS GATOS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2028
Practice Address - Country:US
Practice Address - Phone:408-827-5699
Practice Address - Fax:855-557-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty