Provider Demographics
NPI:1871690214
Name:MYRNA YENTER OUTPATIENT MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:MYRNA YENTER OUTPATIENT MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:YENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS LICSW
Authorized Official - Phone:507-345-5281
Mailing Address - Street 1:1719 KATHLEEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-1936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1719 KATHLEEN DR
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-1936
Practice Address - Country:US
Practice Address - Phone:507-345-5281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00599305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherSOCIAL SECURITY NUMBER