Provider Demographics
NPI:1629102249
Name:ESTRADA, JANA MCGAUGHEY (LMSW)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:MCGAUGHEY
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:DIBOLL
Mailing Address - State:TX
Mailing Address - Zip Code:75941-2031
Mailing Address - Country:US
Mailing Address - Phone:936-674-7981
Mailing Address - Fax:936-633-0613
Practice Address - Street 1:503 HILL ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-2792
Practice Address - Country:US
Practice Address - Phone:936-632-1250
Practice Address - Fax:936-633-0613
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39392104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker