Provider Demographics
NPI:1275642324
Name:YELLIN, PAMELA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:YELLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74076-0375
Mailing Address - Country:US
Mailing Address - Phone:405-372-9000
Mailing Address - Fax:405-377-5607
Practice Address - Street 1:406 S DUNCAN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3281
Practice Address - Country:US
Practice Address - Phone:405-372-9000
Practice Address - Fax:405-377-5607
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK879103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100837730AMedicaid
OK234527903Medicaid