Provider Demographics
NPI:1043959315
Name:YEOMANS, CARISSA LYNN
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:LYNN
Last Name:YEOMANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N KENT ST
Mailing Address - Street 2:
Mailing Address - City:LEROY
Mailing Address - State:MI
Mailing Address - Zip Code:49655-9701
Mailing Address - Country:US
Mailing Address - Phone:231-388-5201
Mailing Address - Fax:
Practice Address - Street 1:4473 220TH AVE
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-8593
Practice Address - Country:US
Practice Address - Phone:231-832-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511150771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty