Provider Demographics
NPI:1306341433
Name:YANEZ-SOUTHARD, YSELDA TAMI (PHD)
Entity type:Individual
Prefix:DR
First Name:YSELDA
Middle Name:TAMI
Last Name:YANEZ-SOUTHARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 NE 13TH STREET
Mailing Address - Street 2:AMHC 3G100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73014
Mailing Address - Country:US
Mailing Address - Phone:405-456-5183
Mailing Address - Fax:
Practice Address - Street 1:921 NE 13TH STREET
Practice Address - Street 2:AMHC 3G100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73014
Practice Address - Country:US
Practice Address - Phone:405-456-5183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33799103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical