Provider Demographics
NPI:1003319781
Name:YATES, STEPHANIE (LCPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6072 BRYNWOOD DR STE 107
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5829
Mailing Address - Country:US
Mailing Address - Phone:815-846-0684
Mailing Address - Fax:
Practice Address - Street 1:6072 BRYNWOOD DR STE 107
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5829
Practice Address - Country:US
Practice Address - Phone:815-846-0684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18457-130101YA0400X
IL178.013882101YP2500X
WI3859-226101YP2500X
IL180.013193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)