Provider Demographics
NPI:1972340834
Name:YEGGE, MALLORY ROSE (LMHC)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:ROSE
Last Name:YEGGE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 N ARMENIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1661
Mailing Address - Country:US
Mailing Address - Phone:813-404-3962
Mailing Address - Fax:
Practice Address - Street 1:2902 N ARMENIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1661
Practice Address - Country:US
Practice Address - Phone:813-404-3962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health