Provider Demographics
NPI:1790503209
Name:UNBRIDLED CHANCES PSYCHOTHERAPY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:UNBRIDLED CHANCES PSYCHOTHERAPY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YULE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-930-0967
Mailing Address - Street 1:2108 N ST STE N
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5712
Mailing Address - Country:US
Mailing Address - Phone:310-929-8789
Mailing Address - Fax:
Practice Address - Street 1:314 S PROSPECT AVE APT 3
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3552
Practice Address - Country:US
Practice Address - Phone:310-930-0967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty