Healthcare Provider Details

I. General information

NPI: 1548917925
Provider Name (Legal Business Name): JOHN OLIVER YCARO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SAN MATEO AVE
LOS GATOS CA
95030-4321
US

IV. Provider business mailing address

15931 FOREST HILL DR.
BOULDER CREEK CA
95006
US

V. Phone/Fax

Practice location:
  • Phone: 408-351-0422
  • Fax:
Mailing address:
  • Phone: 408-393-2875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC9132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: