Provider Demographics
NPI:1417473018
Name:ANGELA YEATES MSLCPC LLC
Entity Type:Organization
Organization Name:ANGELA YEATES MSLCPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEATES
Authorized Official - Suffix:
Authorized Official - Credentials:MSLCPC
Authorized Official - Phone:815-404-3365
Mailing Address - Street 1:1572 LILAC DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1955
Mailing Address - Country:US
Mailing Address - Phone:815-404-3365
Mailing Address - Fax:815-365-7139
Practice Address - Street 1:2200 HUNTINGTON DR N
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-4419
Practice Address - Country:US
Practice Address - Phone:815-404-3365
Practice Address - Fax:815-356-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003737101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty