Provider Demographics
NPI:1184215782
Name:HAILE, YORDANOS (BA)
Entity Type:Individual
Prefix:
First Name:YORDANOS
Middle Name:
Last Name:HAILE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13418 NAPLES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2263
Mailing Address - Country:US
Mailing Address - Phone:832-638-2990
Mailing Address - Fax:
Practice Address - Street 1:7435 HIGHWAY 6 STE F
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5135
Practice Address - Country:US
Practice Address - Phone:281-713-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20136013106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician