Healthcare Provider Details

I. General information

NPI: 1376289512
Provider Name (Legal Business Name): MAYRA Y CORREA BARADA PYSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAYRA Y BARADA PSYD

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 W LINCOLN AVE
YAKIMA WA
98902-2473
US

IV. Provider business mailing address

501 S 5TH AVE
YAKIMA WA
98902-3550
US

V. Phone/Fax

Practice location:
  • Phone: 509-452-4520
  • Fax: 509-452-5224
Mailing address:
  • Phone: 509-853-1082
  • Fax: 509-452-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61288087
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY61418763
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61418763
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: