Provider Demographics
NPI:1811527070
Name:YELEN, EUGENIA ROSE (MMFT)
Entity type:Individual
Prefix:MRS
First Name:EUGENIA
Middle Name:ROSE
Last Name:YELEN
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HARNETT CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1966
Mailing Address - Country:US
Mailing Address - Phone:615-438-3615
Mailing Address - Fax:931-443-0079
Practice Address - Street 1:2031 N MOUNT JULIET RD STE 201
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3316
Practice Address - Country:US
Practice Address - Phone:615-438-3615
Practice Address - Fax:931-443-0079
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist