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General NPI Number Information
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NPI Number | 1669460929
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Entity Type | Individual
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Provider Name | STEPHEN R YERIAN PSY D
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Gender | Male
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 04/07/2018
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Provider Practice Location Address
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Address Line | 4881 SUGAR MAPLE DR
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City | WPAFB
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State | OH
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Zip | 45433-5529
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Country | US
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Telephone | 937-257-6877
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Fax | 937-656-1192
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Provider Business Mailing Address
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Address Line | 1028 S MAIN ST
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-1958
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Country | US
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Telephone | 740-335-2720
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5440
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License Number State | OH
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