Provider Demographics
NPI:1003249871
Name:QUIVEORS, YASNA (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:YASNA
Middle Name:
Last Name:QUIVEORS
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:YASNA
Other - Middle Name:C
Other - Last Name:PROVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 KEATS CT
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1112
Mailing Address - Country:US
Mailing Address - Phone:505-803-1811
Mailing Address - Fax:
Practice Address - Street 1:2904 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6338
Practice Address - Country:US
Practice Address - Phone:575-491-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0197371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional