Provider Demographics
NPI:1194470278
Name:YETTO, JESSICA (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:YETTO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 TURNING LEAF WAY
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9111
Mailing Address - Country:US
Mailing Address - Phone:601-223-9686
Mailing Address - Fax:
Practice Address - Street 1:33 TURNING LEAF WAY
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9111
Practice Address - Country:US
Practice Address - Phone:601-223-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2017Medicaid