Healthcare Provider Details

I. General information

NPI: 1003698796
Provider Name (Legal Business Name): KAISHA D. YEAGER LPC-ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 ROOSEVELT ST
BORGER TX
79007-4427
US

IV. Provider business mailing address

103 OZMER ST
BORGER TX
79007-6613
US

V. Phone/Fax

Practice location:
  • Phone: 806-457-4200
  • Fax:
Mailing address:
  • Phone: 806-274-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number90921
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: