Healthcare Provider Details

I. General information

NPI: 1265009625
Provider Name (Legal Business Name): MISS LYUBOV G YEVSEYEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUBY G YEVSEYEVA BEHAVIORAL THERAPIST

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ALABAMA ST
HUNTINGTON BEACH CA
92648-5203
US

IV. Provider business mailing address

101 ALABAMA ST
HUNTINGTON BEACH CA
92648-5203
US

V. Phone/Fax

Practice location:
  • Phone: 916-709-1855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: