Healthcare Provider Details

I. General information

NPI: 1477200889
Provider Name (Legal Business Name): ISAAC ESQUIVEL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2022
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 WEST HIGHWAY 114, SUITE 200
SOUTHLAKE TX
76092
US

IV. Provider business mailing address

516 TAYLOR DR
ROCKWALL TX
75087-0508
US

V. Phone/Fax

Practice location:
  • Phone: 877-504-8904
  • Fax: 855-420-6402
Mailing address:
  • Phone: 469-264-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number65422
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: