Healthcare Provider Details

I. General information

NPI: 1396896320
Provider Name (Legal Business Name): TIFFANY LYN ESTES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 WOODSTREAM COVE
LITTLE ROCK AR
72211
US

IV. Provider business mailing address

2200 FORT ROOTS DR
NORTH LITTLE ROCK AR
72114-1709
US

V. Phone/Fax

Practice location:
  • Phone: 501-221-3868
  • Fax:
Mailing address:
  • Phone: 501-257-2321
  • Fax: 501-257-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2136-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: