Provider Demographics
NPI:1861965634
Name:DE LEON, JULIETTE YVETTE
Entity type:Individual
Prefix:MRS
First Name:JULIETTE
Middle Name:YVETTE
Last Name:DE LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JULIETTE
Other - Middle Name:YVETTE
Other - Last Name:DE LEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6800 PARK TEN BLVD STE 200S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4293
Mailing Address - Country:US
Mailing Address - Phone:210-261-1060
Mailing Address - Fax:
Practice Address - Street 1:104 STORY LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-2547
Practice Address - Country:US
Practice Address - Phone:210-261-3350
Practice Address - Fax:210-261-1793
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional