Healthcare Provider Details

I. General information

NPI: 1316371487
Provider Name (Legal Business Name): BRANDON ANDREW YABKO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 E PARLEYS WAY STE 203
SALT LAKE CITY UT
84109-1630
US

IV. Provider business mailing address

2681 E PARLEYS WAY STE 203
SALT LAKE CITY UT
84109-1630
US

V. Phone/Fax

Practice location:
  • Phone: 385-355-1018
  • Fax:
Mailing address:
  • Phone: 661-312-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8819350-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: