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 |