Basic Information
| Provider Information | |||||||||
| NPI: | 1902900145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NALL | ||||||||
| FirstName: | YOLANDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NALL | ||||||||
| OtherFirstName: | YOLANDA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3731 KINDLE LN | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730729102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053888393 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4301 MOW-WAY ROAD | ||||||||
| Address2: | REYNOLD'S ARMY COMMUNITY HOSPITAL (ATTN MS PRESCOTT | ||||||||
| City: | FORT SILL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804582134 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2006 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2744 | OK | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 2744 | OK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.