Provider Demographics
NPI:1003698796
Name:YEAGER, KAISHA D (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:KAISHA
Middle Name:D
Last Name:YEAGER
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 OZMER ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-6613
Mailing Address - Country:US
Mailing Address - Phone:806-274-1668
Mailing Address - Fax:
Practice Address - Street 1:1301 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4427
Practice Address - Country:US
Practice Address - Phone:806-457-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional