Provider Demographics
NPI:1518022185
Name:YELLOW, AMY J (CCDCIII)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:J
Last Name:YELLOW
Suffix:
Gender:F
Credentials:CCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-2415
Mailing Address - Country:US
Mailing Address - Phone:605-845-7181
Mailing Address - Fax:605-845-5072
Practice Address - Street 1:12451 HWY 1806
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601
Practice Address - Country:US
Practice Address - Phone:605-845-7181
Practice Address - Fax:605-845-5072
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD00041103101YA0400X
ND1438101YA0400X
SD18191041C0700X
ND15531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical