Provider Demographics
NPI:1932336088
Name:YORK, KEITH (MFT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:YORK
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WILBUR ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3027
Mailing Address - Country:US
Mailing Address - Phone:510-978-1116
Mailing Address - Fax:
Practice Address - Street 1:2450 PERALTA BLVD STE 212
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3826
Practice Address - Country:US
Practice Address - Phone:510-978-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44127106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist