Provider Demographics
| NPI: | 1033442256 |
|---|---|
| Name: | YUTSIS, MAYA (PHD) |
| Entity type: | Individual |
| Prefix: | |
| First Name: | MAYA |
| Middle Name: | |
| Last Name: | YUTSIS |
| Suffix: | |
| Gender: | F |
| Credentials: | PHD |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 300 PASTEUR DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | STANFORD |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 94305-2200 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 650-723-4000 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 300 PASTEUR DR |
| Practice Address - Street 2: | |
| Practice Address - City: | STANFORD |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 94305-2200 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 650-723-4000 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2009-09-08 |
| Last Update Date: | 2023-10-17 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| CA | PSY24931 | 103G00000X, 2084N0400X |
| WA | PY60227321 | 2081H0002X, 2081N0008X, 2081P0010X, 2081P0004X, 103TC0700X, 103TR0400X, 103TP0016X |
| 103T00000X, 103TA0700X, 103TA0400X, 103TC1900X, 103TP0814X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
| Yes | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | |
| No | 2081H0002X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Hospice and Palliative Medicine |
| No | 2081N0008X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Neuromuscular Medicine |
| No | 2081P0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine |
| No | 2081P0004X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
| No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation |
| No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |
| No | 103TP0814X | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis |