Provider Demographics
NPI:1437575818
Name:ESTRADA BRAVO, LUCILA (LMFT)
Entity Type:Individual
Prefix:
First Name:LUCILA
Middle Name:
Last Name:ESTRADA BRAVO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 M ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1805
Mailing Address - Country:US
Mailing Address - Phone:559-600-9300
Mailing Address - Fax:559-488-6826
Practice Address - Street 1:1225 M ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721
Practice Address - Country:US
Practice Address - Phone:559-600-9300
Practice Address - Fax:559-488-6826
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73447106H00000X
CALMFT100401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist