Healthcare Provider Details

I. General information

NPI: 1780347310
Provider Name (Legal Business Name): Y YORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SW 46TH CT APT 1004
OCALA FL
34474-6271
US

IV. Provider business mailing address

477 GOLF HILL CT
GREEN LAKE WI
54941-8839
US

V. Phone/Fax

Practice location:
  • Phone: 954-512-0351
  • Fax:
Mailing address:
  • Phone: 954-512-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CAROLYNN WHITE
Title or Position: DIRECTOR
Credential: LMFT
Phone: 954-512-0351