Provider Demographics
NPI:1861674004
Name:FARRALES, MILYNNE IBARRA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MILYNNE
Middle Name:IBARRA
Last Name:FARRALES
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MILYNNE
Other - Middle Name:GAIL
Other - Last Name:IBARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2055 TREEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-1244
Mailing Address - Country:US
Mailing Address - Phone:408-464-5370
Mailing Address - Fax:
Practice Address - Street 1:1555 PARKMOOR AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2407
Practice Address - Country:US
Practice Address - Phone:408-282-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health