Provider Demographics
NPI:1013323286
Name:ROSALES, YANIRA GRACE (LMSW)
Entity Type:Individual
Prefix:
First Name:YANIRA
Middle Name:GRACE
Last Name:ROSALES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 PONDER ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2711
Mailing Address - Country:US
Mailing Address - Phone:361-227-4751
Mailing Address - Fax:361-878-7684
Practice Address - Street 1:1023 PONDER ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2711
Practice Address - Country:US
Practice Address - Phone:361-227-4751
Practice Address - Fax:361-878-7684
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51697171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator