Healthcare Provider Details

I. General information

NPI: 1104235951
Provider Name (Legal Business Name): YEATES CONSULTING ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 BRICKERTON ST
COLUMBUS MS
39701-3608
US

IV. Provider business mailing address

39 MAID MARION CIR
COLUMBUS MS
39705-3024
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-3110
  • Fax:
Mailing address:
  • Phone: 662-328-3110
  • Fax: 662-328-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1835
License Number StateMS

VIII. Authorized Official

Name: EDWARD L YEATES
Title or Position: PRESIDENT/CEO
Credential: LPC
Phone: 662-328-3110