MEDICARE: OLGA ALEXANDRA YATZUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PC-0000362	DE

General Provider Information

NPI Number	:	1972664050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA ALEXANDRA YATZUS

Provider Business Mailing Address
First Line	:	5700 KIRKWOOD HWY
Second Line	:	SUITE 203
City	:	WILMINGTON
State	:	DE
Zip	:	19808-4857
Country	:	US
Telephone Number	:	302-273-1634
Fax Number	:	302-407-6988

Provider Business Practice Location Address
First Line	:	5700 KIRKWOOD HWY
Second Line	:	SUITE 203
City	:	WILMINGTON
State	:	DE
Zip	:	19808-4857
Country	:	US
Telephone Number	:	302-273-1634
Fax Number	:	302-407-6988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	04/24/2017

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