Provider Demographics
NPI:1396896874
Name:MENDEZ-YBANEZ, GLORIA JEAN (LPC)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:MENDEZ-YBANEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:JEAN
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4203 WOODCOCK DR
Mailing Address - Street 2:SUITE 265
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1320
Mailing Address - Country:US
Mailing Address - Phone:210-737-2674
Mailing Address - Fax:210-734-2412
Practice Address - Street 1:4203 WOODCOCK DR
Practice Address - Street 2:SUITE 265
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1320
Practice Address - Country:US
Practice Address - Phone:210-737-2674
Practice Address - Fax:210-734-2412
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15665101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0288508-03Medicaid
TX0288508-04Medicaid