Provider Demographics
NPI:1205204831
Name:AUDREY J YEATON PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:AUDREY J YEATON PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:YEATON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCSW
Authorized Official - Phone:207-337-5507
Mailing Address - Street 1:433 US ROUTE 1
Mailing Address - Street 2:SUITE 215
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1659
Mailing Address - Country:US
Mailing Address - Phone:207-337-5507
Mailing Address - Fax:
Practice Address - Street 1:433 US ROUTE 1
Practice Address - Street 2:SUITE 215
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1659
Practice Address - Country:US
Practice Address - Phone:207-337-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC11472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty