Provider Demographics
NPI:1316484868
Name:AIMWELL CENTER LLC
Entity type:Organization
Organization Name:AIMWELL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESTIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT, LAC
Authorized Official - Phone:318-235-9735
Mailing Address - Street 1:PO BOX 7319
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-7319
Mailing Address - Country:US
Mailing Address - Phone:318-237-5741
Mailing Address - Fax:318-342-1089
Practice Address - Street 1:1106 STUBBS AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-237-5741
Practice Address - Fax:318-342-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA758101YA0400X
LA1870101YP2500X
LA107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty