Provider Demographics
NPI:1013284645
Name:YEAGER, COREY EUGENE (COREY YEAGER, LMFT)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:EUGENE
Last Name:YEAGER
Suffix:
Gender:M
Credentials:COREY YEAGER, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10593 NOBLE CIR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1122
Mailing Address - Country:US
Mailing Address - Phone:612-312-6107
Mailing Address - Fax:
Practice Address - Street 1:4290 FOX RIDGE RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2253
Practice Address - Country:US
Practice Address - Phone:612-312-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist