Provider Demographics
NPI:1720421548
Name:YBARRA, REGINA KAKHNOVETS (PH D)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:KAKHNOVETS
Last Name:YBARRA
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:KAKHNOVETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PH D
Mailing Address - Street 1:7000 PARKWOOD BLVD
Mailing Address - Street 2:SUITE G400
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7406
Mailing Address - Country:US
Mailing Address - Phone:214-618-0588
Mailing Address - Fax:877-345-4565
Practice Address - Street 1:7000 PARKWOOD BLVD
Practice Address - Street 2:SUITE G400
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7406
Practice Address - Country:US
Practice Address - Phone:214-618-0588
Practice Address - Fax:877-345-4565
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3144103TC1900X
AL1670103TC1900X
TX36962103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling