Healthcare Provider Details

I. General information

NPI: 1558553370
Provider Name (Legal Business Name): ANGELA L YEATES M.S., L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HUNTINGTON DR N
ALGONQUIN IL
60102-4419
US

IV. Provider business mailing address

1572 LILAC DR
CRYSTAL LAKE IL
60014-1955
US

V. Phone/Fax

Practice location:
  • Phone: 815-404-3365
  • Fax: 815-356-7139
Mailing address:
  • Phone: 815-404-3365
  • Fax: 847-368-0764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180003737
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-003737
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: