MEDICARE: VONCEIL C YARA LMFT LPCC

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	101YP2500X	Professional Counselor	10891	CA
2	106H00000X	Marriage & Family Therapist	1345519	CA

General Provider Information

NPI Number	:	1255038188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VONCEIL C YARA LMFT LPCC

Provider Business Mailing Address
First Line	:	693 DOUGLASS ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-3140
Country	:	US
Telephone Number	:	310-480-5838
Fax Number	:

Provider Business Practice Location Address
First Line	:	693 DOUGLASS ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-3140
Country	:	US
Telephone Number	:	310-480-5838
Fax Number	:

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

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	02/10/2023

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