Provider Demographics
NPI:1801310859
Name:YATES, CHARLAY (MA, MT-BC, LMHC)
Entity type:Individual
Prefix:
First Name:CHARLAY
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:MA, MT-BC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 WILLARD ST STE 400
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7469
Mailing Address - Country:US
Mailing Address - Phone:857-269-3752
Mailing Address - Fax:
Practice Address - Street 1:859 WILLARD ST STE 400
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7469
Practice Address - Country:US
Practice Address - Phone:857-269-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12485101YM0800X
MA12025225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist