Provider Demographics
NPI:1447460324
Name:YATES, ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E HILLCREST DR
Mailing Address - Street 2:STE 115
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5828
Mailing Address - Country:US
Mailing Address - Phone:805-370-1756
Mailing Address - Fax:805-495-6970
Practice Address - Street 1:325 E HILLCREST DR
Practice Address - Street 2:STE 115
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5828
Practice Address - Country:US
Practice Address - Phone:805-370-1756
Practice Address - Fax:805-495-6970
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical