Provider Demographics
NPI:1447534797
Name:YBARRA, MARIANNA ANDREA
Entity type:Individual
Prefix:
First Name:MARIANNA
Middle Name:ANDREA
Last Name:YBARRA
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 1:2675 S JONES BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5609
Mailing Address - Country:US
Mailing Address - Phone:702-951-9751
Mailing Address - Fax:702-825-2584
Practice Address - Street 1:2675 S JONES BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5609
Practice Address - Country:US
Practice Address - Phone:702-951-9751
Practice Address - Fax:702-825-2584
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health