Provider Demographics
NPI:1124119581
Name:ESTES, BONNIE L (LPC)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:L
Last Name:ESTES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:BONNIE
Other - Middle Name:MCEVER
Other - Last Name:ESTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1100 STONE ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662
Mailing Address - Country:US
Mailing Address - Phone:903-986-9114
Mailing Address - Fax:903-988-0243
Practice Address - Street 1:116 N MARSHALL ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652
Practice Address - Country:US
Practice Address - Phone:903-655-8569
Practice Address - Fax:903-655-8569
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83163LOtherBLUE CROSS BLUE SHIELD
TX127235OtherCITIP