Healthcare Provider Details

I. General information

NPI: 1952817447
Provider Name (Legal Business Name): ESTELLA V MOLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ESTELLA V MOLINA LPC

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10008 PILOT AVE
MIDLAND TX
79706-2615
US

IV. Provider business mailing address

10008 PILOT AVE
MIDLAND TX
79706-2615
US

V. Phone/Fax

Practice location:
  • Phone: 432-563-4144
  • Fax: 432-561-8611
Mailing address:
  • Phone: 432-563-4144
  • Fax: 432-561-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number70620
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: