Provider Demographics
NPI:1700422342
Name:JESSIE MAE ESTRADA, LPC, PLLC
Entity Type:Organization
Organization Name:JESSIE MAE ESTRADA, LPC, PLLC
Other - Org Name:MARIPOSA EATING RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CEDS
Authorized Official - Phone:210-687-2939
Mailing Address - Street 1:PO BOX 29783
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0783
Mailing Address - Country:US
Mailing Address - Phone:210-687-2939
Mailing Address - Fax:
Practice Address - Street 1:1852 LOCKHILL SELMA RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1500
Practice Address - Country:US
Practice Address - Phone:210-687-2939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty