Provider Demographics
NPI:1578024469
Name:MARISSA W. YEAMAN, PLLC
Entity type:Organization
Organization Name:MARISSA W. YEAMAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:W
Authorized Official - Last Name:YEAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:405-602-4736
Mailing Address - Street 1:4008 MORAIN CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-5020
Mailing Address - Country:US
Mailing Address - Phone:405-602-4736
Mailing Address - Fax:
Practice Address - Street 1:2500 MCGEE DR STE 126
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-6705
Practice Address - Country:US
Practice Address - Phone:405-602-4736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty