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NPI Code Detail

MEDICARE: MS. JULIE KAY YAEKEL-BLACK ELK PHD LPCC

MEDICARE: MS. JULIE KAY YAEKEL-BLACK ELK PHD LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor3776-125WI
2101YM0800XMental Health CounselorMN LPCC 00588MN

General Provider Information

NPI Number : 1487785069
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JULIE KAY YAEKEL-BLACK ELK PHD LPCC
Provider Business Mailing Address
First Line : 49659 STATE LINE RD
Second Line :
City : SANDSTONE
State : MN
Zip : 55072-3032
Country : US
Telephone Number : 218-590-1932
Fax Number :
Provider Business Practice Location Address
First Line : 112 1ST ST W
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-4002
Country : US
Telephone Number : 218-888-8032
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 05/25/2021

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