Provider Demographics
NPI:1306272257
Name:YEARGIN, FRANK WOODROW SR (LISAC)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:WOODROW
Last Name:YEARGIN
Suffix:SR
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17569 W VOLTAIRE ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-5056
Mailing Address - Country:US
Mailing Address - Phone:602-999-9447
Mailing Address - Fax:602-252-0830
Practice Address - Street 1:17569 W VOLTAIRE ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-5056
Practice Address - Country:US
Practice Address - Phone:602-999-9447
Practice Address - Fax:602-252-0830
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC1005101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)