Provider Demographics
NPI:1619238375
Name:YARNALL, JAMES THEADORE (CADC II)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:THEADORE
Last Name:YARNALL
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SCENIC DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6131
Mailing Address - Country:US
Mailing Address - Phone:408-390-3961
Mailing Address - Fax:209-558-4339
Practice Address - Street 1:800 SCENIC DR BLDG B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:408-390-3961
Practice Address - Fax:209-558-4339
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY1002121424101Y00000X, 374700000X
CAAII053610318101YA0400X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No374700000XNursing Service Related ProvidersTechnician