Healthcare Provider Details

I. General information

NPI: 1679355697
Provider Name (Legal Business Name): ESTILL BEHAVIORAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 RIVER DR
IRVINE KY
40336-1255
US

IV. Provider business mailing address

721 RIVER DR
IRVINE KY
40336-1255
US

V. Phone/Fax

Practice location:
  • Phone: 859-749-8768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA YOUNG-FLYNN
Title or Position: APRN, PMHNP-BC
Credential: APRN
Phone: 859-749-8768