Active NPI
Clancy J. Yeager, PCC-S, LICDC
- Professional Counselor
- Perrysburg, OH
National Provider Identifier
1780917617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E.0006531
- Practice address
- 27072 Carronade Dr.
Suite a
Perrysburg, OH 43551 - Phone
- (419) 872-2419
- Fax
- (419) 872-0926
- NPI assigned
- Sep 10, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 954391 | OH | |
| Professional Counselor | 101YP2500X | E.0006531 | OH | Primary |
Addresses
Primary practice location
27072 Carronade Dr.
Suite a
Perrysburg, OH 43551
Mailing address
PO Box 29
Behavioral Connections
Bowling Green, OH 43402
Phone (419) 872-2419
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 954391 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| E.0006531 | OH | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252540800000",
"number": "1780917617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 29",
"address_2": "BEHAVIORAL CONNECTIONS",
"city": "BOWLING GREEN",
"state": "OH",
"postal_code": "43402",
"telephone_number": "419-872-2419",
"fax_number": "419-872-0926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27072 CARRONADE DR.",
"address_2": "SUITE A",
"city": "PERRYSBURG",
"state": "OH",
"postal_code": "43551",
"telephone_number": "419-872-2419",
"fax_number": "419-872-0926"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YEAGER",
"first_name": "CLANCY",
"middle_name": "J.",
"credential": "PCC-S, LICDC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-09-10",
"last_updated": "2009-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "954391",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E.0006531",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Perrysburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.