Provider Demographics
NPI:1194075150
Name:ESTES BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:ESTES BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-NP
Authorized Official - Phone:270-295-6450
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:1210 4TH STREET
Mailing Address - City:LEWISPORT
Mailing Address - State:KY
Mailing Address - Zip Code:42351-0297
Mailing Address - Country:US
Mailing Address - Phone:270-295-6450
Mailing Address - Fax:270-295-6452
Practice Address - Street 1:1210 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISPORT
Practice Address - State:KY
Practice Address - Zip Code:42351-2526
Practice Address - Country:US
Practice Address - Phone:270-295-6450
Practice Address - Fax:270-295-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004576363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100325350Medicaid
KYK060130Medicare PIN