Provider Demographics
NPI:1912664327
Name:MAYDEAN YATES
Entity Type:Organization
Organization Name:MAYDEAN YATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYDEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-360-6014
Mailing Address - Street 1:606 S GLEN AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4675
Mailing Address - Country:US
Mailing Address - Phone:813-360-6014
Mailing Address - Fax:813-358-3605
Practice Address - Street 1:217 N LOIS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2232
Practice Address - Country:US
Practice Address - Phone:813-360-6014
Practice Address - Fax:813-358-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty