Provider Demographics
NPI:1154560753
Name:YANDRICHA, LAURA SUZANNA (CADC)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:SUZANNA
Last Name:YANDRICHA
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-0695
Mailing Address - Country:US
Mailing Address - Phone:405-390-8131
Mailing Address - Fax:405-601-0324
Practice Address - Street 1:14625 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8728
Practice Address - Country:US
Practice Address - Phone:405-390-8131
Practice Address - Fax:405-601-0324
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MHNA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)