Provider Demographics
NPI:1609231455
Name:MYLES, YOLANDA (LMSW)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:MYLES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 STRATFORD CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7346
Mailing Address - Country:US
Mailing Address - Phone:832-744-2975
Mailing Address - Fax:
Practice Address - Street 1:4621 STRATFORD CT
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-7346
Practice Address - Country:US
Practice Address - Phone:832-744-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60172104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty