Provider Demographics
NPI:1114457264
Name:ESTRADA, CHRISTOPHER TRAVIS (QMHA 1, PSS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TRAVIS
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:QMHA 1, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3413
Mailing Address - Country:US
Mailing Address - Phone:541-682-3551
Mailing Address - Fax:541-682-9861
Practice Address - Street 1:432 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3451
Practice Address - Country:US
Practice Address - Phone:541-682-4464
Practice Address - Fax:541-858-8167
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
PROFESSIONALLICENSE175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist