Healthcare Provider Details

I. General information

NPI: 1932904174
Provider Name (Legal Business Name): TYLER YEATTS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 KITTY HAWK SQ
LYNCHBURG VA
24502-4394
US

IV. Provider business mailing address

168 KITTY HAWK SQ
LYNCHBURG VA
24502-4394
US

V. Phone/Fax

Practice location:
  • Phone: 143-494-1028
  • Fax:
Mailing address:
  • Phone: 434-941-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701013860
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: