MEDICARE: OLIVIA DARLENE ESTRADA MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	78550	TX

General Provider Information

NPI Number	:	1275982753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA DARLENE ESTRADA MS, LPC

Provider Business Mailing Address
First Line	:	1430 COLLIER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-2911
Country	:	US
Telephone Number	:	512-472-4357
Fax Number	:	512-703-1394

Provider Business Practice Location Address
First Line	:	4920 N IH 35 STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-2725
Country	:	US
Telephone Number	:	512-854-1800
Fax Number	:	512-854-1920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	07/25/2019

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