Healthcare Provider Details

I. General information

NPI: 1578702254
Provider Name (Legal Business Name): DAVID A. YEATS L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 WALNUT ST SUITE 200
BOULDER CO
80302-5362
US

IV. Provider business mailing address

711 WALNUT ST SUITE 200
BOULDER CO
80302-5362
US

V. Phone/Fax

Practice location:
  • Phone: 303-335-9170
  • Fax: 303-444-8064
Mailing address:
  • Phone: 303-444-8064
  • Fax: 303-444-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number989213
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: