Provider Demographics
NPI:1912156977
Name:YAKICH, THERESA MARIE (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MARIE
Last Name:YAKICH
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3578 HARTSEL DR
Mailing Address - Street 2:UNIT E-117
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2103
Mailing Address - Country:US
Mailing Address - Phone:719-799-3259
Mailing Address - Fax:719-260-6667
Practice Address - Street 1:3578 HARTSEL DR
Practice Address - Street 2:UNIT E-117
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2103
Practice Address - Country:US
Practice Address - Phone:719-799-3259
Practice Address - Fax:719-260-6667
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-06-2915103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral