Healthcare Provider Details

I. General information

NPI: 1376873729
Provider Name (Legal Business Name): WILLIAM G YEATTS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 SMU BLVD # 600723
DALLAS TX
75206-5018
US

IV. Provider business mailing address

5606 SMU BLVD # 600723
DALLAS TX
75206-5018
US

V. Phone/Fax

Practice location:
  • Phone: 469-323-7076
  • Fax: 888-778-1449
Mailing address:
  • Phone: 469-323-7076
  • Fax: 888-778-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number15288
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number15288
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number15288
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: