Provider Demographics
NPI:1841781085
Name:ESTRADA, LUCELY MAGDALENA (COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:LUCELY
Middle Name:MAGDALENA
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 W IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-5021
Mailing Address - Country:US
Mailing Address - Phone:323-750-2850
Mailing Address - Fax:
Practice Address - Street 1:1841 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-5021
Practice Address - Country:US
Practice Address - Phone:323-750-2850
Practice Address - Fax:323-750-0851
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1238181216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty