Provider Demographics
NPI:1720273097
Name:YATES, KRISTINA (MFT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4523
Mailing Address - Country:US
Mailing Address - Phone:510-655-5518
Mailing Address - Fax:
Practice Address - Street 1:3124 LINDEN ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-4523
Practice Address - Country:US
Practice Address - Phone:510-655-5518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist