Provider Demographics
NPI:1306988027
Name:ESTES, MYRA ERNESTINE (CATC)
Entity type:Individual
Prefix:MISS
First Name:MYRA
Middle Name:ERNESTINE
Last Name:ESTES
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11436 GLADSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:91342-7103
Mailing Address - Country:US
Mailing Address - Phone:818-897-6769
Mailing Address - Fax:
Practice Address - Street 1:7621 CANOGA AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-4912
Practice Address - Country:US
Practice Address - Phone:818-598-6930
Practice Address - Fax:818-719-9152
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner