Provider Demographics
NPI:1639460181
Name:YBARRA, PHILLIP B (LPCC, LAADC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:B
Last Name:YBARRA
Suffix:
Gender:M
Credentials:LPCC, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32605 TEMECULA PKWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6837
Mailing Address - Country:US
Mailing Address - Phone:760-443-1397
Mailing Address - Fax:951-695-2161
Practice Address - Street 1:32605 TEMECULA PKWY
Practice Address - Street 2:SUITE 303
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6837
Practice Address - Country:US
Practice Address - Phone:760-443-1397
Practice Address - Fax:951-695-2161
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11360101YA0400X
CALPCC12138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)