Provider Demographics
NPI:1962729038
Name:SEBALLO, YVONNE BERNADETTE (LMHC)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:BERNADETTE
Last Name:SEBALLO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0364
Mailing Address - Country:US
Mailing Address - Phone:407-902-5576
Mailing Address - Fax:407-298-9166
Practice Address - Street 1:2704 REW CIR
Practice Address - Street 2:SUITE 105F
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2994
Practice Address - Country:US
Practice Address - Phone:407-902-5576
Practice Address - Fax:407-298-9166
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7443101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional