Provider Demographics
NPI:1740689462
Name:ACOSTA, ESTELLA (LMFT)
Entity type:Individual
Prefix:
First Name:ESTELLA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ESTELLA
Other - Middle Name:R
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1031 W SANETTA ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651
Mailing Address - Country:US
Mailing Address - Phone:208-514-6886
Mailing Address - Fax:
Practice Address - Street 1:524 CLEVELAND BLVD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4076
Practice Address - Country:US
Practice Address - Phone:208-514-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLAMFT-5545106H00000X
IDLMFT-6552106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist