Provider Demographics
NPI:1992498794
Name:YEAROUT, HARLEY LAWSON (LSAA)
Entity type:Individual
Prefix:
First Name:HARLEY
Middle Name:LAWSON
Last Name:YEAROUT
Suffix:
Gender:M
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 MONTGOMERY BLVD NE STE V
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2470
Mailing Address - Country:US
Mailing Address - Phone:505-507-7984
Mailing Address - Fax:
Practice Address - Street 1:3939 SAN PEDRO DR NE BLDG D1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8905
Practice Address - Country:US
Practice Address - Phone:505-217-1717
Practice Address - Fax:505-213-0041
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0076101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)