Provider Demographics
NPI: | 1669460929 |
---|---|
Name: | YERIAN, STEPHEN R (PSY D) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | STEPHEN |
Middle Name: | R |
Last Name: | YERIAN |
Suffix: | |
Gender: | M |
Credentials: | PSY D |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1028 S MAIN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | WASHINGTON COURT HOUSE |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43160-1958 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 740-335-2720 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4881 SUGAR MAPLE DR |
Practice Address - Street 2: | |
Practice Address - City: | WPAFB |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45433-5529 |
Practice Address - Country: | US |
Practice Address - Phone: | 937-257-6877 |
Practice Address - Fax: | 937-656-1192 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-10-11 |
Last Update Date: | 2018-04-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 5440 | 103TC0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 11585412 | Other | CAQH |
OH | 367267 | Other | MHN |
OH | 560694 | Other | VALUEOPTIONS |
OH | 9398707 | Other | PHCS |
OH | 000000374749 | Other | ANTHEM |
OH | 310952952003 | Other | HEALTHNET |
OH | 9398707 | Other | PHCS |