Provider Demographics
NPI:1861774887
Name:YBARRA, JOHNNY RAY (MS, LBA, LCDC)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:RAY
Last Name:YBARRA
Suffix:
Gender:M
Credentials:MS, LBA, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8546 BROADWAY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6340
Mailing Address - Country:US
Mailing Address - Phone:210-526-1806
Mailing Address - Fax:210-547-7984
Practice Address - Street 1:8546 BROADWAY STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6340
Practice Address - Country:US
Practice Address - Phone:210-526-1806
Practice Address - Fax:210-547-7984
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12124101YA0400X
TX8005103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty