Healthcare Provider Details

I. General information

NPI: 1851459333
Provider Name (Legal Business Name): JEFFREY JOHN YETTER M.ED., LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 MANCHESTER AVE
MIDDLETOWN OH
45042-1925
US

IV. Provider business mailing address

1131 MANCHESTER AVE
MIDDLETOWN OH
45042-1925
US

V. Phone/Fax

Practice location:
  • Phone: 513-423-3327
  • Fax: 513-423-3676
Mailing address:
  • Phone: 513-423-3327
  • Fax: 513-423-3676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE3357
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: