Basic Information
| Provider Information | |||||||||
| NPI: | 1548711351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZHAO | ||||||||
| FirstName: | YINAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| OtherLastName: | ZHAO | ||||||||
| OtherFirstName: | YINAN | ||||||||
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| OtherCredential: | M.S. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3221 BEHRMAN PL STE 201 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701148204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042632800 | ||||||||
| FaxNumber: | 5042632900 | ||||||||
| Practice Location | |||||||||
| Address1: | 3221 BEHRMAN PL STE 201 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701148204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042632800 | ||||||||
| FaxNumber: | 5042632900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2016 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 25100000X | 05 | LA | MEDICAID |