Provider Demographics
NPI:1669416798
Name:TEJEDA, YVONNE M (LPC)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:M
Last Name:TEJEDA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3031 IH 10 W
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 NW LOOP 410 STE 1110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-844-1296
Practice Address - Fax:210-738-8025
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176871501Medicaid