Doctor Name: | DR. ELLEN YEAGLE |
NPI Number: | 1114388279 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D, LMHC |
License Number: | PMH 1251 |
Business Practice Address: | 3640 N Federal Hwy Ste B3 #128 Lighthouse Point, FL - 330646648 |
Business Phone Number: | 6095295815 |
Business Fax Number: | |
Mailing Address: | 940 Sweetwater Ln Apt 313, BOCA RATON |
State: | FL |
Postal Code: | 334317125 |
Phone Number: | 6095295815 |
Fax Number: | |
NPI Enumeration Date: | 03/16/2016 |
NPI Last Update Date: | 03/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | PMH 1251 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |