Provider Demographics
NPI:1689551285
Name:CEDILLO ALVIZO, YAZARI (LMSW)
Entity type:Individual
Prefix:
First Name:YAZARI
Middle Name:
Last Name:CEDILLO ALVIZO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 S HENDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3567
Mailing Address - Country:US
Mailing Address - Phone:903-985-7444
Mailing Address - Fax:
Practice Address - Street 1:2019 S HENDERSON BLVD UNIT 15
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3567
Practice Address - Country:US
Practice Address - Phone:903-985-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115715104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker