Provider Demographics
NPI:1013962737
Name:YNOSTROSA-TRAVERS, EDWARD PHILIP (LPC-S)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:PHILIP
Last Name:YNOSTROSA-TRAVERS
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:PHILIP
Other - Last Name:TRAVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-S
Mailing Address - Street 1:702 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212
Mailing Address - Country:US
Mailing Address - Phone:210-299-2400
Mailing Address - Fax:
Practice Address - Street 1:702 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212
Practice Address - Country:US
Practice Address - Phone:210-299-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16354101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional