Provider Demographics
NPI:1780480673
Name:SUELEN YANCOR LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SUELEN YANCOR LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUELEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:YANCOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-341-6258
Mailing Address - Street 1:6104 SEPULVEDA BLVD # 1001
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2503
Mailing Address - Country:US
Mailing Address - Phone:818-213-1045
Mailing Address - Fax:
Practice Address - Street 1:10401 ENGER ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2726
Practice Address - Country:US
Practice Address - Phone:818-213-1045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)