Provider Demographics
NPI:1083736086
Name:YODER, TODD D (LMFT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:YODER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 FLAGSTAFF COVE
Mailing Address - Street 2:HARVEST COUNSELING GROUP INC
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4417
Mailing Address - Country:US
Mailing Address - Phone:260-485-4357
Mailing Address - Fax:260-485-4357
Practice Address - Street 1:4216 FLAGSTAFF COVE
Practice Address - Street 2:HARVEST COUNSELING GROUP
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4417
Practice Address - Country:US
Practice Address - Phone:260-485-4357
Practice Address - Fax:260-485-4357
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001505A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000492914OtherANTHEM
IN474734OtherVALUE OPTIONS