Provider Demographics
NPI:1881603181
Name:YATES-EAMICK, NANCY KAY (NCC, LPC, LPCC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:KAY
Last Name:YATES-EAMICK
Suffix:
Gender:F
Credentials:NCC, LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-6133
Mailing Address - Country:US
Mailing Address - Phone:505-863-3828
Mailing Address - Fax:505-863-6612
Practice Address - Street 1:2025 E AZTEC AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4803
Practice Address - Country:US
Practice Address - Phone:505-863-3828
Practice Address - Fax:505-863-6612
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0082501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00JK91Medicaid