Provider Demographics
NPI:1821393349
Name:ESTRADA, MARTIN (CADCI, CPS)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:CADCI, CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 SW CORBETH LN
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-3176
Mailing Address - Country:US
Mailing Address - Phone:503-318-5551
Mailing Address - Fax:
Practice Address - Street 1:3014 SW CORBETH LN
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-3176
Practice Address - Country:US
Practice Address - Phone:503-318-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-06-15101YA0400X
OR09-CPS-004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174400000XOther Service ProvidersSpecialist