Basic Information
| Provider Information | |||||||||
| NPI: | 1417197021 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YORE | ||||||||
| FirstName: | DOUGLAS | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 DEVONSHIRE DR | ||||||||
| Address2: | STE B1 | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618207337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173836792 | ||||||||
| FaxNumber: | 2173834752 | ||||||||
| Practice Location | |||||||||
| Address1: | 1813 W. KIRBY AVENUE | ||||||||
| Address2: | PSYCHIATRY/PSYCHOLOGY | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618215410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173831850 | ||||||||
| FaxNumber: | 2173833439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2009 | ||||||||
| LastUpdateDate: | 07/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149011993 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.