Provider Demographics
NPI:1790834570
Name:YELDER, LISA DIANE (LMSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:YELDER
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 1:19445 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3361
Mailing Address - Country:US
Mailing Address - Phone:313-307-0088
Mailing Address - Fax:313-281-2235
Practice Address - Street 1:15800 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3566
Practice Address - Country:US
Practice Address - Phone:313-334-8980
Practice Address - Fax:313-659-9216
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801058737101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health