Healthcare Provider Details

I. General information

NPI: 1629995782
Provider Name (Legal Business Name): AVORIE SHALANE YATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 BECHELLI LN
REDDING CA
96002-1954
US

IV. Provider business mailing address

2590 CALIFORNIA PARK DR APT 29
CHICO CA
95928-4017
US

V. Phone/Fax

Practice location:
  • Phone: 530-232-0845
  • Fax:
Mailing address:
  • Phone: 530-232-0845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: