Provider Demographics
NPI:1760758940
Name:JODI CEBALLOS, PSY.D., PLLC
Entity Type:Organization
Organization Name:JODI CEBALLOS, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CEBALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:830-313-6268
Mailing Address - Street 1:901 N BEDELL AVE STE F
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-4170
Mailing Address - Country:US
Mailing Address - Phone:830-313-6268
Mailing Address - Fax:830-433-8228
Practice Address - Street 1:901 N BEDELL AVE STE F
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4170
Practice Address - Country:US
Practice Address - Phone:830-313-6268
Practice Address - Fax:830-433-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34985103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286660001Medicaid
TXTXB140482Medicare UPIN