Healthcare Provider Details

I. General information

NPI: 1194075150
Provider Name (Legal Business Name): ESTES BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 4TH ST
LEWISPORT KY
42351-2526
US

IV. Provider business mailing address

PO BOX 297 1210 4TH STREET
LEWISPORT KY
42351-0297
US

V. Phone/Fax

Practice location:
  • Phone: 270-295-6450
  • Fax: 270-295-6452
Mailing address:
  • Phone: 270-295-6450
  • Fax: 270-295-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3004576
License Number StateKY

VIII. Authorized Official

Name: JESSICA L ESTES
Title or Position: OWNER
Credential: APRN-NP
Phone: 270-295-6450