Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 32569 | TX |
NPI | 1073776779 |
---|---|
Provider Name | Dr. Miguel Antonio Ybarra |
First Address | Austin, TX 78748-2989 |
Second Address | San Antonio, TX 78229-4404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 03/07/2008 |