Provider Demographics
NPI:1508396110
Name:YELLOW HORSE-RUIZ, KATORA MAE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATORA
Middle Name:MAE
Last Name:YELLOW HORSE-RUIZ
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 1:1795 LLAGAS RD
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-9547
Mailing Address - Country:US
Mailing Address - Phone:669-253-0940
Mailing Address - Fax:
Practice Address - Street 1:1685 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5104
Practice Address - Country:US
Practice Address - Phone:408-445-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA948721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator