Provider Demographics
NPI:1174651764
Name:YAKE, NEIL B (LPC, LMSW, CSW)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:B
Last Name:YAKE
Suffix:
Gender:M
Credentials:LPC, LMSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 824
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48501-0824
Mailing Address - Country:US
Mailing Address - Phone:810-735-8427
Mailing Address - Fax:
Practice Address - Street 1:6379 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9566
Practice Address - Country:US
Practice Address - Phone:989-777-4357
Practice Address - Fax:989-777-7257
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801017559104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0995910OtherHEALTH PLUS - BRIDGEPORT
MI0995847OtherHEALTH PLUS - FLINT
MI1014831OtherMCLAREN HEALTH
MI1014831OtherMCLAREN HEALTH ADVANTAGE