Basic Information
| Provider Information | |||||||||
| NPI: | 1700391075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YAO | ||||||||
| FirstName: | ELAINE | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 W DUARTE RD APT C | ||||||||
| Address2: | |||||||||
| City: | MONROVIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910167448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268638638 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9353 VALLEY BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | ROSEMEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917701934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262872988 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2017 | ||||||||
| LastUpdateDate: | 12/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 101115 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.