Provider Demographics
NPI:1902654965
Name:YEM, SOMPORSH ANITA
Entity Type:Individual
Prefix:
First Name:SOMPORSH
Middle Name:ANITA
Last Name:YEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E MERCER ST STE A
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4037
Mailing Address - Country:US
Mailing Address - Phone:512-820-3825
Mailing Address - Fax:512-919-4045
Practice Address - Street 1:151 E MERCER ST STE A
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4037
Practice Address - Country:US
Practice Address - Phone:512-820-3825
Practice Address - Fax:512-919-4045
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician