Basic Information
Provider Information
NPI: 1588790885
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEESE
FirstName: YVONNE
MiddleName: HALL
NamePrefix: MS.
NameSuffix:  
Credential: MFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 384 REDONDO AVE UNIT 204
Address2:  
City: LONG BEACH
State: CA
PostalCode: 908147071
CountryCode: US
TelephoneNumber: 5628565508
FaxNumber:  
Practice Location
Address1: 1055 W VICTORIA ST
Address2:  
City: COMPTON
State: CA
PostalCode: 902205804
CountryCode: US
TelephoneNumber: 3108685379
FaxNumber: 3108685397
Other Information
ProviderEnumerationDate: 02/23/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XMFC32376CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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