Provider Demographics
NPI:1205342219
Name:VILLARREAL, DELIA YAZMIN (MA, LPA)
Entity type:Individual
Prefix:
First Name:DELIA
Middle Name:YAZMIN
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2963
Mailing Address - Country:US
Mailing Address - Phone:956-739-7974
Mailing Address - Fax:
Practice Address - Street 1:807 QUINCE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2445
Practice Address - Country:US
Practice Address - Phone:956-800-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36716103TC0700X
261QD1600X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health