Provider Demographics
NPI:1740977321
Name:YUTUC, VERNON
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:
Last Name:YUTUC
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 1:4026 WOODLAND PARK AVE N UNIT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7918
Mailing Address - Country:US
Mailing Address - Phone:425-891-0342
Mailing Address - Fax:
Practice Address - Street 1:7900 E GREEN LAKE DR N STE 202
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4818
Practice Address - Country:US
Practice Address - Phone:206-659-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health