Provider Demographics
NPI:1720050974
Name:JANA, YAMILE (CLINICAL PSYCH)
Entity Type:Individual
Prefix:
First Name:YAMILE
Middle Name:
Last Name:JANA
Suffix:
Gender:F
Credentials:CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20455 1ST AVE NE
Mailing Address - Street 2:APT H103
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9319
Mailing Address - Country:US
Mailing Address - Phone:443-370-2888
Mailing Address - Fax:
Practice Address - Street 1:20455 1ST AVE NE
Practice Address - Street 2:APT H103
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9319
Practice Address - Country:US
Practice Address - Phone:443-370-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1306103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN