Provider Demographics
NPI:1053501429
Name:YEP MARTIN, MICHELLE JEANNE (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEANNE
Last Name:YEP MARTIN
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 WORONZOF DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1495
Mailing Address - Country:US
Mailing Address - Phone:907-227-5802
Mailing Address - Fax:907-677-7472
Practice Address - Street 1:3601 C ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5923
Practice Address - Country:US
Practice Address - Phone:907-227-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health