Provider Demographics
NPI:1467283580
Name:FERNANDEZ, ELENA RYBALKO (MED, NCC, LPC-A)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:RYBALKO
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MED, NCC, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10907 MEMORIAL HERMANN DR STE 340
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4194
Mailing Address - Country:US
Mailing Address - Phone:346-633-3642
Mailing Address - Fax:
Practice Address - Street 1:10907 MEMORIAL HERMANN DR STE 340
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4194
Practice Address - Country:US
Practice Address - Phone:346-633-3642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-10
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional