Healthcare Provider Details

I. General information

NPI: 1366828147
Provider Name (Legal Business Name): TIMOTHY YEAGER BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5048 N JACKSON AVE
FRESNO CA
93740-0001
US

IV. Provider business mailing address

5048 N JACKSON AVE
FRESNO CA
93740-0001
US

V. Phone/Fax

Practice location:
  • Phone: 559-288-8670
  • Fax:
Mailing address:
  • Phone: 559-288-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: