Healthcare Provider Details

I. General information

NPI: 1619238375
Provider Name (Legal Business Name): JAMES THEADORE YARNALL CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR BLDG B
MODESTO CA
95350-6131
US

IV. Provider business mailing address

800 SCENIC DR BLDG B
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 408-390-3961
  • Fax: 209-558-4339
Mailing address:
  • Phone: 408-390-3961
  • Fax: 209-558-4339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberY1002121424
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII053610318
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberY1002121424
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberAII053610318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: