Provider Demographics
NPI:1952783268
Name:ESTRADA, RICARDA (LCDC)
Entity Type:Individual
Prefix:
First Name:RICARDA
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7722 N LOOP DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-2907
Mailing Address - Country:US
Mailing Address - Phone:915-782-4014
Mailing Address - Fax:915-850-0249
Practice Address - Street 1:7722 N LOOP DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-2907
Practice Address - Country:US
Practice Address - Phone:915-782-4014
Practice Address - Fax:915-850-0249
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10410101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10410OtherDSHS