Provider Demographics
NPI:1386939817
Name:YAHOLA, RICHARD DEAN
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DEAN
Last Name:YAHOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:DEAN
Other - Last Name:YAHOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1408 S SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:WEWOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74884-3919
Mailing Address - Country:US
Mailing Address - Phone:469-247-4058
Mailing Address - Fax:
Practice Address - Street 1:1408 S SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-3919
Practice Address - Country:US
Practice Address - Phone:469-247-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1531101YP2500X
TX13457101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional