Provider Demographics
NPI:1750051884
Name:ADEYEYE, YEMI EMMANUEL
Entity Type:Individual
Prefix:
First Name:YEMI
Middle Name:EMMANUEL
Last Name:ADEYEYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 BLUEBONNET DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3765
Mailing Address - Country:US
Mailing Address - Phone:469-374-1789
Mailing Address - Fax:
Practice Address - Street 1:720 BLUEBONNET DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3765
Practice Address - Country:US
Practice Address - Phone:469-374-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool