Provider Demographics
NPI:1235729740
Name:IBARRA, LYDIA DOMINGUEZ (MA)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:DOMINGUEZ
Last Name:IBARRA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12714 ARCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3605
Mailing Address - Country:US
Mailing Address - Phone:316-500-0985
Mailing Address - Fax:
Practice Address - Street 1:12714 ARCHWOOD LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-3605
Practice Address - Country:US
Practice Address - Phone:316-500-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health