Healthcare Provider Details

I. General information

NPI: 1871624676
Provider Name (Legal Business Name): JENNIFER YATES MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 OLD RANCH PKWY SUITE 300
SEAL BEACH CA
90740-2765
US

IV. Provider business mailing address

3020 OLD RANCH PKWY SUITE 300
SEAL BEACH CA
90740-2765
US

V. Phone/Fax

Practice location:
  • Phone: 562-799-5559
  • Fax:
Mailing address:
  • Phone: 562-799-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC43968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: