Provider Demographics
NPI:1275946212
Name:YATES, JESSICA FOGLE (LMHC-A)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:FOGLE
Last Name:YATES
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10311 RANDALL DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-4755
Mailing Address - Country:US
Mailing Address - Phone:812-369-1559
Mailing Address - Fax:
Practice Address - Street 1:10311 RANDALL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-4755
Practice Address - Country:US
Practice Address - Phone:812-369-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000025A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health