Provider Demographics
NPI:1487785069
Name:YAEKEL-BLACK ELK, JULIE KAY (PHD LPCC)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:KAY
Last Name:YAEKEL-BLACK ELK
Suffix:
Gender:F
Credentials:PHD LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49659 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-3032
Mailing Address - Country:US
Mailing Address - Phone:218-590-1932
Mailing Address - Fax:
Practice Address - Street 1:112 1ST ST W
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4002
Practice Address - Country:US
Practice Address - Phone:218-888-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3776-125101YM0800X
MNMN LPCC 00588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health