Provider Demographics
NPI:1467732032
Name:YBARRA-TIPTON, ELISA YVETTE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:YVETTE
Last Name:YBARRA-TIPTON
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 1:2805 FOUNTAIN PLAZA BLVD.
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8031
Mailing Address - Country:US
Mailing Address - Phone:956-316-2224
Mailing Address - Fax:956-316-2224
Practice Address - Street 1:1904 E. GRIFFIN PARKWAY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3106
Practice Address - Country:US
Practice Address - Phone:956-585-2439
Practice Address - Fax:956-585-3145
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51021104100000X
TX32660171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173943501Medicaid