Provider Demographics
NPI:1376054015
Name:ESTRADA, TEENA N (RBT-17-42605)
Entity Type:Individual
Prefix:
First Name:TEENA
Middle Name:N
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:RBT-17-42605
Other - Prefix:
Other - First Name:TEENA
Other - Middle Name:N
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT-17-42605
Mailing Address - Street 1:7220 W JEFFERSON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2023
Mailing Address - Country:US
Mailing Address - Phone:303-225-7673
Mailing Address - Fax:866-283-0595
Practice Address - Street 1:7220 W JEFFERSON AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2023
Practice Address - Country:US
Practice Address - Phone:303-225-7673
Practice Address - Fax:866-283-0595
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-17-42605106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician