Healthcare Provider Details

I. General information

NPI: 1619772571
Provider Name (Legal Business Name): JDA YEAW PSYCHOLOGICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

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: 719-425-7763
  • Fax:
Mailing address:
  • Phone: 719-425-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN DAVID ANDREW YEAW
Title or Position: OWNER
Credential: PSYD
Phone: 719-725-7761