Provider Demographics
NPI:1831224377
Name:YEAGER, CAROL A (MA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:YEAGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 VALLEY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6330
Mailing Address - Country:US
Mailing Address - Phone:636-256-9173
Mailing Address - Fax:314-984-0006
Practice Address - Street 1:13545 BARRETT PARKWAY DR
Practice Address - Street 2:SUITE 150
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-3822
Practice Address - Country:US
Practice Address - Phone:314-984-0901
Practice Address - Fax:314-984-0006
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional