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General NPI Number Information
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NPI Number | 1922730357
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Entity Type | Organization
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Legal Business Name | SB YAB CO.
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Dates
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Enumeration Date | 06/24/2022
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 699 E SOUTH TEMPLE STE 300A
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1188
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Country | US
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Telephone | 385-355-1018
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Fax |
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Provider Business Mailing Address
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Address Line | 699 E SOUTH TEMPLE STE 300A
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1188
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Country | US
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Telephone | 661-312-9335
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. BRANDON YABKO
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Credential | PHD
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Telephone | 385-355-1018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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