Provider Demographics
NPI:1154090124
Name:YAHYA, MARYAM JEARBELL (LLPC)
Entity Type:Individual
Prefix:MRS
First Name:MARYAM
Middle Name:JEARBELL
Last Name:YAHYA
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4742 FLYING EAGLE DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49548-7563
Mailing Address - Country:US
Mailing Address - Phone:616-498-6484
Mailing Address - Fax:
Practice Address - Street 1:4764 FULTON ST E STE 204
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9086
Practice Address - Country:US
Practice Address - Phone:616-439-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6451019792Medicaid