Basic Information
| Provider Information | |||||||||
| NPI: | 1235715418 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YAKANAK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | HERMAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | BHA III, MSCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2290 | ||||||||
| Address2: | |||||||||
| City: | CORDOVA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995742290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074243622 | ||||||||
| FaxNumber: | 9074243275 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 SECOND ST. | ||||||||
| Address2: | |||||||||
| City: | CORDOVA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995742290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074243622 | ||||||||
| FaxNumber: | 9074243275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2021 | ||||||||
| LastUpdateDate: | 03/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 20174BHAIII | AK | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.