Healthcare Provider Details

I. General information

NPI: 1689250995
Provider Name (Legal Business Name): STACIE ELIZABETH YOQUELET ED.D, NCC, LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 HANSON CT STE 103
MURFREESBORO TN
37129-2765
US

IV. Provider business mailing address

1015 HANSON CT STE 103
MURFREESBORO TN
37129-2765
US

V. Phone/Fax

Practice location:
  • Phone: 615-320-1155
  • Fax:
Mailing address:
  • Phone: 615-320-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1479
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: