Healthcare Provider Details

I. General information

NPI: 1922356690
Provider Name (Legal Business Name): DANIELLE JULIETTE YEATTS LMSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE JULIETTE TICHY

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E 5TH AVE STE 208
MOUNT DORA FL
32757-5523
US

IV. Provider business mailing address

2221 FORD PKWY STE 350
SAINT PAUL MN
55116-3837
US

V. Phone/Fax

Practice location:
  • Phone: 800-336-5973
  • Fax: 612-234-4689
Mailing address:
  • Phone: 800-336-5973
  • Fax: 612-234-4689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093904
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10319
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: