Healthcare Provider Details

I. General information

NPI: 1780986828
Provider Name (Legal Business Name): MIRZA M ESTRADA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10607 MARY SCHEEL LN
CONVERSE TX
78109-4429
US

IV. Provider business mailing address

10607 MARY SCHEEL LN
CONVERSE TX
78109-4429
US

V. Phone/Fax

Practice location:
  • Phone: 956-543-3402
  • Fax:
Mailing address:
  • Phone: 956-543-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number96930
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: