Healthcare Provider Details

I. General information

NPI: 1346500535
Provider Name (Legal Business Name): MR. JEVAUGHN ANTHONY YORKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 S COAST DR STE 202
COSTA MESA CA
92626-1534
US

IV. Provider business mailing address

635 N CHIPPEWA AVE APT 27
ANAHEIM CA
92801-4453
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-5440
  • Fax:
Mailing address:
  • Phone: 323-691-8160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: