Healthcare Provider Details

I. General information

NPI: 1013284645
Provider Name (Legal Business Name): COREY EUGENE YEAGER COREY YEAGER, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4290 FOX RIDGE RD
EAGAN MN
55122-2253
US

IV. Provider business mailing address

10593 NOBLE CIR N
BROOKLYN PARK MN
55443-1122
US

V. Phone/Fax

Practice location:
  • Phone: 612-312-6107
  • Fax:
Mailing address:
  • Phone: 612-312-6107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2237
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: