Provider Demographics
NPI:1639238678
Name:YENTER, MYRNA AGNES (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:AGNES
Last Name:YENTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MYRNA
Other - Middle Name:
Other - Last Name:MICHELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1719 KATHLEEN DR
Mailing Address - Street 2:
Mailing Address - City:N MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-1936
Mailing Address - Country:US
Mailing Address - Phone:507-345-5281
Mailing Address - Fax:507-345-5281
Practice Address - Street 1:1719 KATHLEEN DRIVE
Practice Address - Street 2:
Practice Address - City:N MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-1936
Practice Address - Country:US
Practice Address - Phone:507-345-5281
Practice Address - Fax:507-345-5281
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00599101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical