Provider Demographics
NPI:1831962968
Name:ESTRADA, NISIM YADIEL (LPC)
Entity type:Individual
Prefix:
First Name:NISIM
Middle Name:YADIEL
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 E CORONADO RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1583
Mailing Address - Country:US
Mailing Address - Phone:480-712-4600
Mailing Address - Fax:
Practice Address - Street 1:337 E CORONADO RD STE 201
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1583
Practice Address - Country:US
Practice Address - Phone:480-712-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22541101YP2500X
AZLPC-22541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional