Provider Demographics
NPI:1972775625
Name:ESTRADA, TANYA DIANE (MSW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:DIANE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3800
Mailing Address - Country:US
Mailing Address - Phone:720-838-6568
Mailing Address - Fax:303-926-0837
Practice Address - Street 1:12500 FIRST ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3800
Practice Address - Country:US
Practice Address - Phone:720-838-6568
Practice Address - Fax:303-926-0837
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10174OtherUNLIC PSYCHOTHERAPIST