Provider Demographics
NPI:1952337438
Name:JEREB, BARBARA YANTZ (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:YANTZ
Last Name:JEREB
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:JEREB
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:1510 W FAIRMONT ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-6320
Mailing Address - Country:US
Mailing Address - Phone:903-234-2990
Mailing Address - Fax:903-234-1752
Practice Address - Street 1:1510 W FAIRMONT ST
Practice Address - Street 2:SUITE D
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-6320
Practice Address - Country:US
Practice Address - Phone:903-234-2990
Practice Address - Fax:903-234-1752
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148834OtherVALUE OPTIONS
TX2042LCOtherBLUECROSS/BLUESHIELD