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General NPI Number Information
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NPI Number | 1548029663
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Entity Type | Individual
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Provider Name | TARA GENEA YATES NEWELL LMFT, CEAP
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Gender | Female
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 2101 W JOHN CARPENTER FREEWAY
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City | IRVING
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State | TX
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Zip | 75063
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Country | US
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Telephone | 404-861-0612
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Fax |
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Provider Business Mailing Address
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Address Line | 6234 HOLLY SPRINGS PKWY STE D9
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City | WOODSTOCK
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State | GA
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Zip | 30188-3051
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001037
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License Number State | GA
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