Healthcare Provider Details

I. General information

NPI: 1669460929
Provider Name (Legal Business Name): STEPHEN R YERIAN PSY D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 04/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WPAFB OH
45433-5529
US

IV. Provider business mailing address

1028 S MAIN ST
WASHINGTON COURT HOUSE OH
43160-1958
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-6877
  • Fax: 937-656-1192
Mailing address:
  • Phone: 740-335-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5440
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: