Provider Demographics
NPI:1538875455
Name:YANG, JACQUELINE MIKYU (LMHC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MIKYU
Last Name:YANG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:MIKYU
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:1 N 4TH PL APT 34J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3355
Mailing Address - Country:US
Mailing Address - Phone:914-714-1780
Mailing Address - Fax:
Practice Address - Street 1:1 N 4TH PL APT 34J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-3355
Practice Address - Country:US
Practice Address - Phone:914-714-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health