Healthcare Provider Details

I. General information

NPI: 1710910104
Provider Name (Legal Business Name): YELLEN & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11260 WILBUR AVE SUITE 303
NORTHRIDGE CA
91326-2450
US

IV. Provider business mailing address

11260 WILBUR AVE SUITE 303
NORTHRIDGE CA
91326-2450
US

V. Phone/Fax

Practice location:
  • Phone: 818-360-3078
  • Fax: 818-360-4327
Mailing address:
  • Phone: 818-360-3078
  • Fax: 818-360-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY10756
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY10756
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10756
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License NumberPSY10756
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10756
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREW G YELLEN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 818-360-3078