Provider Demographics
NPI:1699090571
Name:ESTES, VICKI LYNNE (LCSW)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNNE
Last Name:ESTES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N GREENWOOD AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-1446
Mailing Address - Country:US
Mailing Address - Phone:918-599-7277
Mailing Address - Fax:918-599-7716
Practice Address - Street 1:130 N GREENWOOD AVE STE 302
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-1446
Practice Address - Country:US
Practice Address - Phone:918-599-7277
Practice Address - Fax:918-599-7716
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746170GMedicaid