Provider Demographics
NPI:1225451875
Name:PERRY, YOLANDA FAYE (MBA)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:FAYE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 ABRAM ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-2840
Mailing Address - Country:US
Mailing Address - Phone:405-830-7134
Mailing Address - Fax:405-427-1102
Practice Address - Street 1:1734 ABRAM ROSS AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-2840
Practice Address - Country:US
Practice Address - Phone:405-830-7134
Practice Address - Fax:405-427-1102
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)