Provider Demographics
NPI:1356859292
Name:ESTAVILLO, ALEXANDRA (MAS-MFT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:ESTAVILLO
Suffix:
Gender:F
Credentials:MAS-MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8466 W PEORIA AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6548
Mailing Address - Country:US
Mailing Address - Phone:602-507-7595
Mailing Address - Fax:602-429-8154
Practice Address - Street 1:8466 W PEORIA AVE STE 6
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6548
Practice Address - Country:US
Practice Address - Phone:602-507-7595
Practice Address - Fax:602-429-8154
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health