Healthcare Provider Details

I. General information

NPI: 1326523168
Provider Name (Legal Business Name): MARK G YEAGER BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 OAK GROVE RD.
HATTIESBURG MS
39402
US

IV. Provider business mailing address

1465 LAKELAND DR
JACKSON MS
39216-4719
US

V. Phone/Fax

Practice location:
  • Phone: 601-264-9728
  • Fax:
Mailing address:
  • Phone: 601-352-7784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number180065
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: