Provider Demographics
NPI:1396949053
Name:YEMANE, NATHAN (LCSW)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:YEMANE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 NW 16TH ST APT 128
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3431
Mailing Address - Country:US
Mailing Address - Phone:405-408-9343
Mailing Address - Fax:
Practice Address - Street 1:3908 N PENIEL AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3458
Practice Address - Country:US
Practice Address - Phone:405-408-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical