MEDICARE: MARIAH FAITH YACKUBOSKEY MSCP, LPC, NCC

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	101YM0800X	Mental Health Counselor	PC12632	PA

General Provider Information

NPI Number	:	1083200315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH FAITH YACKUBOSKEY MSCP, LPC, NCC

Provider Business Mailing Address
First Line	:	5000 MCKNIGHT RD STE 202
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-3420
Country	:	US
Telephone Number	:	412-366-8342
Fax Number	:	412-366-8346

Provider Business Practice Location Address
First Line	:	1018 PERALTA ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-5002
Country	:	US
Telephone Number	:	412-366-8342
Fax Number	:	412-366-8346

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

Provider Enumeration Date	:	12/21/2020
Last Update Date	:	12/21/2020

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