Healthcare Provider Details

I. General information

NPI: 1174985436
Provider Name (Legal Business Name): TIFFANY YEAGER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY GONZALES BCBA

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6158 E TERRACE AVE
FRESNO CA
93727-8960
US

IV. Provider business mailing address

6158 E TERRACE AVE
FRESNO CA
93727-8960
US

V. Phone/Fax

Practice location:
  • Phone: 559-904-4385
  • Fax:
Mailing address:
  • Phone: 559-904-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-19093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: