Provider Demographics
NPI:1881839793
Name:YELEK, CECILY GREEN (CMT, LMT)
Entity Type:Individual
Prefix:
First Name:CECILY
Middle Name:GREEN
Last Name:YELEK
Suffix:
Gender:F
Credentials:CMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7199 COUNTY ROAD P
Mailing Address - Street 2:
Mailing Address - City:SUNRAY
Mailing Address - State:TX
Mailing Address - Zip Code:79086-7120
Mailing Address - Country:US
Mailing Address - Phone:806-753-4400
Mailing Address - Fax:
Practice Address - Street 1:401 N 3RD ST.
Practice Address - Street 2:#3
Practice Address - City:STRATFORD
Practice Address - State:TX
Practice Address - Zip Code:79084
Practice Address - Country:US
Practice Address - Phone:806-290-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT107769225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist