Healthcare Provider Details

I. General information

NPI: 1831218858
Provider Name (Legal Business Name): REBECCA GAIL YASUNAGA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 12/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 ATLAS DR
WHITEMAN AFB MO
65305-1279
US

IV. Provider business mailing address

705 ATLAS DR
WHITEMAN AFB MO
65305-1279
US

V. Phone/Fax

Practice location:
  • Phone: 501-288-2588
  • Fax: 501-288-2588
Mailing address:
  • Phone: 501-288-2588
  • Fax: 501-288-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number06-38P
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0638P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: