Healthcare Provider Details

I. General information

NPI: 1568539880
Provider Name (Legal Business Name): TERRENCE W YEAGER LPC,CAC,CEAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 W 26TH ST FL 2
ERIE PA
16508-1402
US

IV. Provider business mailing address

1330 W 26TH ST FL 2
ERIE PA
16508-1402
US

V. Phone/Fax

Practice location:
  • Phone: 814-451-2345
  • Fax: 814-451-2348
Mailing address:
  • Phone: 814-451-2345
  • Fax: 814-451-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC000778
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: