MEDICARE: THERESA YORK M.S., LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-17-26563	CA

General Provider Information

NPI Number	:	1023512084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA YORK M.S., LBA

Provider Business Mailing Address
First Line	:	3186 AIRWAY AVE STE A
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4650
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21727 W INTERSTATE 10 STE 108
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-2108
Country	:	US
Telephone Number	:	855-782-7822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	12/15/2020

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