Healthcare Provider Details

I. General information

NPI: 1356690689
Provider Name (Legal Business Name): ROBERT D YATES III PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 DOWNING AVE STE 60
HAYS KS
67601-2461
US

IV. Provider business mailing address

1010 DOWNING AVE STE 60
HAYS KS
67601-2461
US

V. Phone/Fax

Practice location:
  • Phone: 785-621-4417
  • Fax: 866-473-6903
Mailing address:
  • Phone: 785-621-4417
  • Fax: 866-473-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number572
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2318
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: