Healthcare Provider Details

I. General information

NPI: 1215852579
Provider Name (Legal Business Name): DAN T YECHOUT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANIEL T YECHOUT

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 TERRY ST
LONGMONT CO
80501-5930
US

IV. Provider business mailing address

5699 BOULDER HILLS DR
LONGMONT CO
80503-8812
US

V. Phone/Fax

Practice location:
  • Phone: 303-819-7476
  • Fax:
Mailing address:
  • Phone: 303-819-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: