MEDICARE: YOLANDA FAYE PERRY MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		OK

General Provider Information

NPI Number	:	1225451875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA FAYE PERRY MBA

Provider Business Mailing Address
First Line	:	1734 ABRAM ROSS AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-2840
Country	:	US
Telephone Number	:	405-830-7134
Fax Number	:	405-427-1102

Provider Business Practice Location Address
First Line	:	1734 ABRAM ROSS AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-2840
Country	:	US
Telephone Number	:	405-830-7134
Fax Number	:	405-427-1102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2014
Last Update Date	:	01/31/2014

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