Provider Demographics
NPI:1699787358
Name:ESTES, M DIANE (LMHP CPC RN)
Entity type:Individual
Prefix:MRS
First Name:M
Middle Name:DIANE
Last Name:ESTES
Suffix:
Gender:F
Credentials:LMHP CPC RN
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:ABERCROMBIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3007 S 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3409
Mailing Address - Country:US
Mailing Address - Phone:402-391-7353
Mailing Address - Fax:
Practice Address - Street 1:2833 S 87TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3046
Practice Address - Country:US
Practice Address - Phone:402-398-9852
Practice Address - Fax:402-398-9852
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025268200Medicaid