1548551278

Everything you always wanted to know about DR. YELDER JEROME SR. PH.D., MP-BC, ABMP, but were afraid to ask.

DR. YELDER JEROME SR. PH.D., MP-BC, ABMP,

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Provider Prefix Provider Last Name Provider First Name Provider Suffix Provider Credential
DR. YELDER JEROME SR. PH.D., MP-BC, ABMP,
Gender:
Male
Enumeration date:
2011-04-28
Last update date:
2012-11-14
Current as of:
2007-08-28
Is sole proprietor?:
Yes
Is organization subpart?:
Not Answered
In PECOS?:
No
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Identifiers

identifier description issuer state active
273614612 Medicaid none SC 1

Taxonomies

Taxonomy State License Number Primary?
101YA0400X Addiction (Substance Use Disorder) SC 45428
101YP1600X Pastoral SC 61388
103G00000X Clinical Neuropsychologist SC 573768
103TP0016X Prescribing (Medical) SC 159AMP
171000000X Military Health Care Provider SC 159AMP
171W00000X Contractor SC 73276
174H00000X Health Educator SC 73276
1835P0018X Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist SC 5768
208VP0014X Interventional Pain Medicine SC 159AMP
251B00000X Case Management SC 73276
251E00000X Home Health SC 73276
251K00000X Public Health or Welfare SC 73276
251S00000X Community/Behavioral Health SC 73276
251V00000X Voluntary or Charitable SC 73276
252Y00000X Early Intervention Provider Agency SC 73276

Phone Numbers

Type Number
Mailing Address Telephone Number 8884103130
Practice Location Address Telephone Number 8036679646
Mailing Address Fax Number 8006518252
Practice Location Address Fax Number 8006518252

Addresses

Type Address City State Postal Country
Mailing Address P.O. BOX 30328 COLUMBIA SC 29203 SC
Practice Location Address 5711 N. MAIN STREET SUITE B 5711 N. MAIN STREET SUITE B COLUMBIA SC 0 SC