Provider Demographics
NPI:1932904174
Name:YEATTS, TYLER (LPC)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:YEATTS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 KITTY HAWK SQ
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4394
Mailing Address - Country:US
Mailing Address - Phone:434-941-0289
Mailing Address - Fax:
Practice Address - Street 1:168 KITTY HAWK SQ
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4394
Practice Address - Country:US
Practice Address - Phone:143-494-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013860101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor