Provider Demographics
NPI:1114182250
Name:DEINES, YOLANDA A (LCSW)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:A
Last Name:DEINES
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 1:6501 BOEING DR BLDG F
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1096
Mailing Address - Country:US
Mailing Address - Phone:915-772-8210
Mailing Address - Fax:915-857-9452
Practice Address - Street 1:6501 BOEING DR BLDG F
Practice Address - Street 2:SUITE 2
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1096
Practice Address - Country:US
Practice Address - Phone:915-772-8210
Practice Address - Fax:915-857-9452
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX020021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0090RKOtherBXBS
TX1964801-01Medicaid
TX0090RKOtherBXBS