Provider Demographics
NPI:1184795932
Name:OLIVARES, ESTELA (LICENSED MARRIAGE)
Entity type:Individual
Prefix:MS
First Name:ESTELA
Middle Name:
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:LICENSED MARRIAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 N MAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4309
Mailing Address - Country:US
Mailing Address - Phone:210-226-8407
Mailing Address - Fax:210-226-8420
Practice Address - Street 1:1528 N MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4309
Practice Address - Country:US
Practice Address - Phone:210-226-8407
Practice Address - Fax:210-226-8420
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist