Provider Demographics
NPI:1780917617
Name:YEAGER, CLANCY J (PCC-S, LICDC)
Entity type:Individual
Prefix:
First Name:CLANCY
Middle Name:J
Last Name:YEAGER
Suffix:
Gender:M
Credentials:PCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:BEHAVIORAL CONNECTIONS
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402
Mailing Address - Country:US
Mailing Address - Phone:419-872-2419
Mailing Address - Fax:419-872-0926
Practice Address - Street 1:27072 CARRONADE DR.
Practice Address - Street 2:SUITE A
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551
Practice Address - Country:US
Practice Address - Phone:419-872-2419
Practice Address - Fax:419-872-0926
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH954391101YA0400X
OHE.0006531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)