Healthcare Provider Details

I. General information

NPI: 1396891149
Provider Name (Legal Business Name): JOHN DAVID ANDREW YEAW PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date: 04/23/2025
Reactivation Date: 06/11/2025

III. Provider practice location address

2020 N ACADEMY BLVD STE 276
COLORADO SPRINGS CO
80909-1567
US

IV. Provider business mailing address

2020 N ACADEMY BLVD STE 276
COLORADO SPRINGS CO
80909-1567
US

V. Phone/Fax

Practice location:
  • Phone: 719-425-9673
  • Fax:
Mailing address:
  • Phone: 719-725-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0005694
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32430
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: