Provider Demographics
NPI:1780733766
Name:ESTRADA, MARCIA LUANN (LIMHP, LADC)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:LUANN
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3106
Mailing Address - Country:US
Mailing Address - Phone:308-635-2256
Mailing Address - Fax:308-635-1271
Practice Address - Street 1:416 VALLEY VIEW DR STE 311
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-1420
Practice Address - Country:US
Practice Address - Phone:308-631-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE689101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026260000Medicaid