Provider Demographics
NPI:1588873160
Name:YATES, MARY ELLEN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 UPS DRIVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4046
Mailing Address - Country:US
Mailing Address - Phone:502-339-4511
Mailing Address - Fax:502-339-4513
Practice Address - Street 1:1700 UPS DR
Practice Address - Street 2:SUITE 107
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4046
Practice Address - Country:US
Practice Address - Phone:502-339-4511
Practice Address - Fax:502-339-4513
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105151106H00000X
KY559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist