Provider Demographics
NPI:1699925883
Name:YELLIG, ADRIANA (MASTERS LTD PSYCHOL)
Entity type:Individual
Prefix:MRS
First Name:ADRIANA
Middle Name:
Last Name:YELLIG
Suffix:
Gender:F
Credentials:MASTERS LTD PSYCHOL
Other - Prefix:MS
Other - First Name:ADRIANA
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:801 HAZEN STREET SUITE C
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-0249
Mailing Address - Country:US
Mailing Address - Phone:269-657-5574
Mailing Address - Fax:269-657-3474
Practice Address - Street 1:801 HAZEN STREET
Practice Address - Street 2:SUITE C
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-0249
Practice Address - Country:US
Practice Address - Phone:269-657-5574
Practice Address - Fax:269-657-3474
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013153103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist