Provider Demographics
NPI:1053463505
Name:SULLINS, YANAH TERRY (LMFT)
Entity Type:Individual
Prefix:
First Name:YANAH
Middle Name:TERRY
Last Name:SULLINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 S ROAN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-7556
Mailing Address - Country:US
Mailing Address - Phone:423-231-2518
Mailing Address - Fax:
Practice Address - Street 1:2700 S ROAN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7556
Practice Address - Country:US
Practice Address - Phone:423-231-2518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMT0000000553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist