Healthcare Provider Details

I. General information

NPI: 1285861385
Provider Name (Legal Business Name): BRENDA JOYCE YATES MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 N PARK RD
TEXARKANA TX
75503-2664
US

IV. Provider business mailing address

5221 N PARK RD
TEXARKANA TX
75503-2664
US

V. Phone/Fax

Practice location:
  • Phone: 903-791-1051
  • Fax: 903-791-1054
Mailing address:
  • Phone: 903-791-1051
  • Fax: 903-791-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16789
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: