Healthcare Provider Details

I. General information

NPI: 1972958718
Provider Name (Legal Business Name): ESTES NEUROPSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 FOX POINTE DR STE A
COLUMBUS IN
47203-3391
US

IV. Provider business mailing address

14740 N COUNTY ROAD 350 E
HOPE IN
47246-9623
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-0900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number20042177A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042922A
License Number StateIN

VIII. Authorized Official

Name: DR. BRADLEY ESTES
Title or Position: NEUROPSYCHOLOGIST/DIRECTOR
Credential: PSY.D.
Phone: 812-764-0733