Healthcare Provider Details

I. General information

NPI: 1881938785
Provider Name (Legal Business Name): THOMAS CLIFTON ESTIS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 STUBBS AVENUE SUITE B
MONROE LA
71211
US

IV. Provider business mailing address

1106 STUBBS AVENUE SUITE B
MONROE LA
71211
US

V. Phone/Fax

Practice location:
  • Phone: 318-237-5741
  • Fax: 318-816-5332
Mailing address:
  • Phone: 318-237-5741
  • Fax: 318-816-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number758
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1870
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number107
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: