Healthcare Provider Details

I. General information

NPI: 1104699792
Provider Name (Legal Business Name): ZACHARY ESTRADA LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24422 AVENIDA DE LA CARLOTA STE 190
LAGUNA HILLS CA
92653-3634
US

IV. Provider business mailing address

1112 MANLEY DR
SAN GABRIEL CA
91776-2916
US

V. Phone/Fax

Practice location:
  • Phone: 800-801-9833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC21959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: