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General NPI Number Information
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NPI Number | 1316484868
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Entity Type | Organization
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Legal Business Name | AIMWELL CENTER LLC
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1106 STUBBS AVENUE SUITE B
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-237-5741
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Fax | 318-342-1089
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Provider Business Mailing Address
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Address Line | PO BOX 7319
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City | MONROE
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State | LA
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Zip | 71211-7319
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Country | US
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Telephone | 318-237-5741
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Fax | 318-342-1089
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | THOMAS C ESTIS
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Credential | LPC, LMFT, LAC
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Telephone | 318-235-9735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 758
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 107
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1870
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License Number State | LA
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