Provider Demographics
NPI:1477195519
Name:YEAZLE ILIFF, NATALEE E (LPCC)
Entity type:Individual
Prefix:
First Name:NATALEE
Middle Name:E
Last Name:YEAZLE ILIFF
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14034 JACYLYN DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-7508
Mailing Address - Country:US
Mailing Address - Phone:763-957-9165
Mailing Address - Fax:
Practice Address - Street 1:530 3RD ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1445
Practice Address - Country:US
Practice Address - Phone:763-587-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2241101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional