Provider Demographics
NPI:1649684119
Name:IBARRA, YESENIA RUBY (LCSW)
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:RUBY
Last Name:IBARRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YESENIA
Other - Middle Name:RUBY
Other - Last Name:TREJO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:200 S MAIN ST
Mailing Address - Street 2:STE P1
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3261
Mailing Address - Country:US
Mailing Address - Phone:208-244-6799
Mailing Address - Fax:208-274-9407
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:STE P1
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3261
Practice Address - Country:US
Practice Address - Phone:208-244-6799
Practice Address - Fax:208-274-9407
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-414881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical