Provider Demographics
NPI:1558186551
Name:ESTRADA, RAEJEAN RENETTA (LPC)
Entity type:Individual
Prefix:
First Name:RAEJEAN
Middle Name:RENETTA
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-9493
Mailing Address - Country:US
Mailing Address - Phone:361-827-5154
Mailing Address - Fax:
Practice Address - Street 1:2608 DOGWOOD ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-9493
Practice Address - Country:US
Practice Address - Phone:361-827-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89748101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor