Provider Demographics
NPI:1124234885
Name:PSYCHOTHERAPY SERVICES & YOKEFELLOWS
Entity type:Organization
Organization Name:PSYCHOTHERAPY SERVICES & YOKEFELLOWS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EZIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-338-4471
Mailing Address - Street 1:159 N RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-3911
Mailing Address - Country:US
Mailing Address - Phone:817-338-4471
Mailing Address - Fax:817-338-1811
Practice Address - Street 1:159 N. RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111
Practice Address - Country:US
Practice Address - Phone:817-338-4471
Practice Address - Fax:817-338-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177792201Medicaid