Provider Demographics
NPI:1669460929
Name:YERIAN, STEPHEN R (PSY D)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:YERIAN
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1958
Mailing Address - Country:US
Mailing Address - Phone:740-335-2720
Mailing Address - Fax:
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:WPAFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-257-6877
Practice Address - Fax:937-656-1192
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11585412OtherCAQH
OH367267OtherMHN
OH560694OtherVALUEOPTIONS
OH9398707OtherPHCS
OH000000374749OtherANTHEM
OH310952952003OtherHEALTHNET
OH9398707OtherPHCS