Provider Demographics
NPI:1821007113
Name:VILLALOBOS, GRISELDA (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 N YARBROUGH DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7803
Mailing Address - Country:US
Mailing Address - Phone:915-373-6021
Mailing Address - Fax:844-691-1283
Practice Address - Street 1:1316 N YARBROUGH DR STE 2A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7803
Practice Address - Country:US
Practice Address - Phone:915-373-6021
Practice Address - Fax:844-691-1283
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25440101YM0800X, 101YP2500X, 1041C0700X
TX39303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1721474-02Medicaid
TX1721474-01Medicaid
TX8C8585Medicare ID - Type UnspecifiedDOCS TX00143K
TX1721474-02Medicaid