Healthcare Provider Details

I. General information

NPI: 1720325962
Provider Name (Legal Business Name): CAROLYN ANNE YAWN MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 10TH ST
ARCATA CA
95521-6210
US

IV. Provider business mailing address

PO BOX 5144
ARCATA CA
95518-5144
US

V. Phone/Fax

Practice location:
  • Phone: 707-826-8610
  • Fax: 707-826-8623
Mailing address:
  • Phone: 707-633-3692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT107833
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT107833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: