Provider Demographics
NPI:1760959373
Name:YEARWOOD, GESSICA MEGAN LIESEL (MS COUNSELING)
Entity Type:Individual
Prefix:MS
First Name:GESSICA
Middle Name:MEGAN LIESEL
Last Name:YEARWOOD
Suffix:
Gender:F
Credentials:MS COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 ALAFAYA CLUB DR APT 204
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-6555
Mailing Address - Country:US
Mailing Address - Phone:786-368-4124
Mailing Address - Fax:
Practice Address - Street 1:2479 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2541
Practice Address - Country:US
Practice Address - Phone:407-501-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health