Provider Demographics
NPI:1700810132
Name:FLORES, LETICIA YOLANDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:YOLANDA
Last Name:FLORES
Suffix:
Gender:F
Credentials:PHD
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HENLEY STREET
Mailing Address - Street 2:SUITE 208 UT PSYCHOLOGICAL CLINIC UT CONFERENCE CENTER
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37996
Mailing Address - Country:US
Mailing Address - Phone:865-974-2161
Mailing Address - Fax:865-974-3330
Practice Address - Street 1:600 HENLEY STREET
Practice Address - Street 2:SUITE 208 UT PSYCHOLOGICAL CLINIC UT CONFERENCE CENTER
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996
Practice Address - Country:US
Practice Address - Phone:865-974-2161
Practice Address - Fax:865-974-3330
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810003415103TC0700X
TN3162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008172C11Medicare ID - Type Unspecified
VA01018770Medicaid