Healthcare Provider Details

I. General information

NPI: 1558869701
Provider Name (Legal Business Name): RAYCHEL CHRISTINE YEARSLEY MS, LPC-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 N CENTRAL EXPY STE 150
DALLAS TX
75231-5033
US

IV. Provider business mailing address

9400 N CENTRAL EXPY STE 150
DALLAS TX
75231-5033
US

V. Phone/Fax

Practice location:
  • Phone: 469-341-9133
  • Fax: 214-360-9366
Mailing address:
  • Phone: 469-341-9133
  • Fax: 214-360-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75030
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: