Provider Demographics
NPI:1548753205
Name:YATES, SAMANTHA (CPSS)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 E RIVER PL STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-3442
Mailing Address - Country:US
Mailing Address - Phone:662-592-5397
Mailing Address - Fax:662-627-2442
Practice Address - Street 1:122 DESOTO AVE STE 109
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4440
Practice Address - Country:US
Practice Address - Phone:662-592-5397
Practice Address - Fax:662-627-2442
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health