Provider Demographics
NPI:1225197767
Name:ESTRADA, JOSE CARMEN IX (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:CARMEN
Last Name:ESTRADA
Suffix:IX
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 JIMENO LN
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5304
Mailing Address - Country:US
Mailing Address - Phone:530-406-1658
Mailing Address - Fax:
Practice Address - Street 1:355 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5700
Practice Address - Country:US
Practice Address - Phone:707-553-5810
Practice Address - Fax:707-553-5824
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist