Provider Demographics
NPI:1255061636
Name:ESTRADA, JASON LOUIS (SUDPT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LOUIS
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2334
Mailing Address - Country:US
Mailing Address - Phone:509-469-9366
Mailing Address - Fax:509-469-9926
Practice Address - Street 1:201 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2348
Practice Address - Country:US
Practice Address - Phone:509-457-5633
Practice Address - Fax:509-457-3107
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty