Provider Demographics
NPI:1043547326
Name:WASS, INGRID YASIRELL (LCSW)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:YASIRELL
Last Name:WASS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14603 HUEBNER RD BLDG 32
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5505
Mailing Address - Country:US
Mailing Address - Phone:210-384-2659
Mailing Address - Fax:
Practice Address - Street 1:14603 HUEBNER RD BLDG 32
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5505
Practice Address - Country:US
Practice Address - Phone:210-384-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-08
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0082021041C0700X
TX1100621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical