Basic Information
| Provider Information | |||||||||
| NPI: | 1548892417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YATES | ||||||||
| FirstName: | AKILAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2549 WAUKEGAN RD STE 543 | ||||||||
| Address2: | |||||||||
| City: | BANNOCKBURN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600151569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472204877 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 BELVIDERE RD | ||||||||
| Address2: | |||||||||
| City: | WAUKEGAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600856165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473778800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2020 | ||||||||
| LastUpdateDate: | 08/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 180.012788 | IL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 180.012788 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.