1518781210 NPI number — MISS YVETTE TRACEY LAYALLEE MS, LPCC

Table of content: MISS YVETTE TRACEY LAYALLEE MS, LPCC (NPI 1518781210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518781210 NPI number — MISS YVETTE TRACEY LAYALLEE MS, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAYALLEE
Provider First Name:
YVETTE
Provider Middle Name:
TRACEY
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MS, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRACEY
Provider Other First Name:
YVETTE
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LPCC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1518781210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 EUSTIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-441-7691
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
STE A127
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-266-7900
Provider Business Practice Location Address Fax Number:
651-266-3522
Provider Enumeration Date:
11/11/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  01408 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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