Provider Demographics
NPI:1275964801
Name:YEARTA, DENISE (MS,LPC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:YEARTA
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E WAYLAND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2961
Mailing Address - Country:US
Mailing Address - Phone:417-496-3273
Mailing Address - Fax:417-824-7914
Practice Address - Street 1:2604 W REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-8632
Practice Address - Country:US
Practice Address - Phone:417-496-3273
Practice Address - Fax:417-824-7914
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-08
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999199482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional