Provider Demographics
NPI:1073951943
Name:ESTRADA, JESSIE MAE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:MAE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:LPC
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 29783
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0783
Mailing Address - Country:US
Mailing Address - Phone:210-687-2939
Mailing Address - Fax:
Practice Address - Street 1:1852 LOCKHILL SELMA RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1500
Practice Address - Country:US
Practice Address - Phone:210-687-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional