Healthcare Provider Details

I. General information

NPI: 1356761084
Provider Name (Legal Business Name): JULIE URSULA YLLESCAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N OCCIDENTAL BLVD
LOS ANGELES CA
90026-4641
US

IV. Provider business mailing address

3431 E CURRY ST
LONG BEACH CA
90805-3815
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-2931
  • Fax:
Mailing address:
  • Phone: 562-668-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW 59733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: