Yellow Wood Talk Therapy, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

C004644 Issued in NC

Legal business name

YELLOW WOOD TALK THERAPY, LLC

Practice address

5256 Eider LN
Granite Falls, NC 28630-8754

Phone

(828) 493-0759

Fax

(828) 212-0466

NPI assigned

Jun 6, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paul Anthony Mastrovito, LCSWNPI 1396827481

Title

Ceo

Phone

(828) 493-0759

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Anthony Mastrovito, LCSW

  • Clinical Social Worker
  • Wilmington, NC
  • NPI 1396827481
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601251200000",
    "number": "1992154413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5256 EIDER LN",
            "city": "GRANITE FALLS",
            "state": "NC",
            "postal_code": "286308754",
            "telephone_number": "828-493-0759",
            "fax_number": "828-212-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5256 EIDER LN",
            "city": "GRANITE FALLS",
            "state": "NC",
            "postal_code": "286308754",
            "telephone_number": "828-493-0759",
            "fax_number": "828-212-0466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "219A Avery Ave",
            "address_purpose": "LOCATION",
            "city": "Morganton",
            "state": "NC",
            "postal_code": "286553102",
            "country_code": "US",
            "telephone_number": "828-493-0759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "YELLOW WOOD TALK THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-06",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A",
        "authorized_official_last_name": "MASTROVITO",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "828-493-0759",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "C004644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Granite Falls, NC
• Providers in Granite Falls, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.