Basic Information
| Provider Information | |||||||||
| NPI: | 1083352330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YATES | ||||||||
| FirstName: | RAYMON | ||||||||
| MiddleName: | CLYDE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MA, NCC, LPC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1154 RUSTLING WIND LN | ||||||||
| Address2: | |||||||||
| City: | LEAGUE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775733052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322890499 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6021 FAIRMONT PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775054511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817692238 | ||||||||
| FaxNumber: | 2817692164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2022 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 88608 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.