MEDICARE: JEFFREY YEOM LMFT

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	AMFT126621	CA
2	106H00000X	Marriage & Family Therapist	126621	CA
3	106H00000X	Marriage & Family Therapist	148556	CA

General Provider Information

NPI Number	:	1215690250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY YEOM LMFT

Provider Business Mailing Address
First Line	:	1308 E COLORADO BLVD # 2339
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1932
Country	:	US
Telephone Number	:	626-214-5456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 E COLORADO BLVD # 2339
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1932
Country	:	US
Telephone Number	:	626-214-5456
Fax Number	:

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

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	10/23/2024

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