Provider Demographics
NPI:1689202178
Name:YENTER, NICOLE LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:YENTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 HERITAGE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5571
Mailing Address - Country:US
Mailing Address - Phone:662-235-1836
Mailing Address - Fax:
Practice Address - Street 1:507 HERITAGE DR STE 102
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5571
Practice Address - Country:US
Practice Address - Phone:662-235-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0566101Y00000X
MS2942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty