Healthcare Provider Details

I. General information

NPI: 1467344747
Provider Name (Legal Business Name): ISELA ESTRADA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2025
Last Update Date: 07/19/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6442 W 64TH ST
CHICAGO IL
60638-5008
US

IV. Provider business mailing address

6447 S KARLOV AVE
CHICAGO IL
60629-5101
US

V. Phone/Fax

Practice location:
  • Phone: 773-706-3700
  • Fax:
Mailing address:
  • Phone: 773-706-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number2469162
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License NumberR-DMT-1840
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.010132
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: