Provider Demographics
NPI:1649622325
Name:YACKSYZN, TREVOR
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:YACKSYZN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 SPRING MOUNTAIN RD
Mailing Address - Street 2:APT 203
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-6355
Mailing Address - Country:US
Mailing Address - Phone:702-779-9176
Mailing Address - Fax:
Practice Address - Street 1:9070 SPRING MOUNTAIN RD
Practice Address - Street 2:APT 203
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-6355
Practice Address - Country:US
Practice Address - Phone:702-779-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst