NPIMap

Organization Active NPI

Jenna Reid Yates, PH.D., Licensed Clinical Psychologist, LLC

  • Clinical Psychologist
  • Springfield, IL
National Provider Identifier
1831820547
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
JENNA REID YATES, PH.D., LICENSED CLINICAL PSYCHOLOGIST, LLC
Practice address
3233 Mathers Rd Ste a
Springfield, IL 62711-7900
Phone
(217) 414-2064
NPI assigned
Jun 22, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jenna Yates, PH.D.NPI 1013412931
Title
Psychologist
Phone
(217) 899-5412

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

3233 Mathers Rd Ste a
Springfield, IL 62711-7900

Mailing address

3233 Mathers Rd Ste a
Springfield, IL 62711-7900
Phone (121) 741-4206

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Athenahealth Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Locations

3233 Mathers Rd
Ste A
Springfield, IL 62711
Phone (217) 414-2064

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26421/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655856000000",
    "number": "1831820547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3233 MATHERS RD STE A",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627117900",
            "telephone_number": "121-741-4206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3233 MATHERS RD STE A",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627117900",
            "telephone_number": "217-414-2064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNA REID YATES, PH.D., LICENSED CLINICAL PSYCHOLOGIST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-22",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A",
        "authorized_official_last_name": "YATES",
        "authorized_official_first_name": "JENNA",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "217-899-5412",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Athenahealth",
            "affiliation": "N",
            "endpointDescription": "electronic medical record system",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "info@jennareidyates.com",
            "address_1": "3233 Mathers Rd Ste A",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627117900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.