Provider Demographics
NPI:1982084620
Name:YACKO, LAURA PEEK (PHD, HSPP)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:PEEK
Last Name:YACKO
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ELLEN
Other - Last Name:PEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1503 N MITTHOEFER RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BURDEN CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:IN
Practice Address - Zip Code:46001-2632
Practice Address - Country:US
Practice Address - Phone:765-298-6436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN20043808B103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health