Healthcare Provider Details

I. General information

NPI: 1881603181
Provider Name (Legal Business Name): NANCY KAY YATES-EAMICK NCC, LPC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E AZTEC AVE
GALLUP NM
87301-4803
US

IV. Provider business mailing address

201 E LOGAN AVE
GALLUP NM
87301-6133
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-3828
  • Fax: 505-863-6612
Mailing address:
  • Phone: 505-863-3828
  • Fax: 505-863-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0082501
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: