MEDICARE: RAEJEAN RENETTA ESTRADA 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	89748	TX

General Provider Information

NPI Number	:	1558186551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAEJEAN RENETTA ESTRADA LPC

Provider Business Mailing Address
First Line	:	2608 DOGWOOD ST
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-9493
Country	:	US
Telephone Number	:	361-827-5154
Fax Number	:

Provider Business Practice Location Address
First Line	:	2608 DOGWOOD ST
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-9493
Country	:	US
Telephone Number	:	361-827-5154
Fax Number	:

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

Provider Enumeration Date	:	11/15/2024
Last Update Date	:	05/05/2026

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