Provider Demographics
NPI:1215062179
Name:YAMA, MARK FRANCIS (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:FRANCIS
Last Name:YAMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PSYCHOLOGY AND COMM STUDIES
Mailing Address - Street 2:UNIVERSITY OF IDAHO
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83844-3043
Mailing Address - Country:US
Mailing Address - Phone:208-885-7376
Mailing Address - Fax:208-885-7710
Practice Address - Street 1:PSYCHOLOGY AND COMM STUDIES
Practice Address - Street 2:UNIVERSITY OF IDAHO
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83844-3043
Practice Address - Country:US
Practice Address - Phone:208-885-7376
Practice Address - Fax:208-885-7710
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPSY-204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8060033Medicaid
ID1680580Medicare ID - Type UnspecifiedPROVIDER NUMBER