Provider Demographics
NPI:1760958581
Name:YBARRA, MARISA (LPC)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:YBARRA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:NAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 660253
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-7253
Mailing Address - Country:US
Mailing Address - Phone:512-842-5168
Mailing Address - Fax:512-727-0476
Practice Address - Street 1:345 CYPRESS CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4484
Practice Address - Country:US
Practice Address - Phone:512-842-5168
Practice Address - Fax:512-727-0476
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional