Healthcare Provider Details

I. General information

NPI: 1649420290
Provider Name (Legal Business Name): SCOTT R. YETTMAN MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 THE ALAMEDA STE 201
SAN JOSE CA
95126-2222
US

IV. Provider business mailing address

1671 THE ALAMEDA STE 201
SAN JOSE CA
95126-2222
US

V. Phone/Fax

Practice location:
  • Phone: 408-278-2540
  • Fax:
Mailing address:
  • Phone: 408-278-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: