Provider Demographics
NPI:1700170370
Name:ESTRADA, JACQUELINE (MA, MFT, LADC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:MA, MFT, LADC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:KEENAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4221 MCLEOD DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5215
Mailing Address - Country:US
Mailing Address - Phone:702-474-6450
Mailing Address - Fax:
Practice Address - Street 1:4221 MCLEOD DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5215
Practice Address - Country:US
Practice Address - Phone:702-474-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00485-LC101YA0400X
CAMFC 44416106H00000X
NV01351106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)