Healthcare Provider Details

I. General information

NPI: 1801310859
Provider Name (Legal Business Name): CHARLAY YATES MA, MT-BC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 WILLARD ST STE 400
QUINCY MA
02169-7469
US

IV. Provider business mailing address

859 WILLARD ST STE 400
QUINCY MA
02169-7469
US

V. Phone/Fax

Practice location:
  • Phone: 857-269-3752
  • Fax:
Mailing address:
  • Phone: 857-269-3752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12485
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12025
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: