Provider Demographics
NPI:1912667627
Name:ESTRADA, YAQUELIN DELCARMEN (RBT)
Entity Type:Individual
Prefix:
First Name:YAQUELIN
Middle Name:DELCARMEN
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 LAGO TRL
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-2958
Mailing Address - Country:US
Mailing Address - Phone:323-636-1804
Mailing Address - Fax:
Practice Address - Street 1:311 E STAN SCHLUETER LOOP STE 108
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6436
Practice Address - Country:US
Practice Address - Phone:254-539-5039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-197156106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician