Provider Demographics
NPI:1780872382
Name:YSASI, DESIRAE L (LPC-S)
Entity type:Individual
Prefix:MRS
First Name:DESIRAE
Middle Name:L
Last Name:YSASI
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17806 IH 10 W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-8221
Mailing Address - Country:US
Mailing Address - Phone:210-774-8292
Mailing Address - Fax:210-568-4184
Practice Address - Street 1:17806 IH 10 W
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-8221
Practice Address - Country:US
Practice Address - Phone:210-774-8292
Practice Address - Fax:210-568-4184
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89251LOtherBLUE CROSS BLUE SHIELD