Healthcare Provider Details

I. General information

NPI: 1487094629
Provider Name (Legal Business Name): DAVID AUSTIN YADUSH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 VILLA ST
MOUNTAIN VIEW CA
94041-1236
US

IV. Provider business mailing address

990 VILLA ST
MOUNTAIN VIEW CA
94041-1236
US

V. Phone/Fax

Practice location:
  • Phone: 610-392-2976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC010452
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: