Provider Demographics
NPI:1760836928
Name:YBARRA, TATIANA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:YBARRA
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9003 RESEDA BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3920
Mailing Address - Country:US
Mailing Address - Phone:818-465-9368
Mailing Address - Fax:818-921-4182
Practice Address - Street 1:9003 RESEDA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3920
Practice Address - Country:US
Practice Address - Phone:818-465-9368
Practice Address - Fax:818-921-4182
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist