Basic Information
| Provider Information | |||||||||
| NPI: | 1659843407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESTES | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10100 ELIDA RD | ||||||||
| Address2: | |||||||||
| City: | DELPHOS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458339058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196958010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3540 S HIGHWAY 27 STE 4 | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425013124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066791815 | ||||||||
| FaxNumber: | 6064511631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2018 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 253724 | KY | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | 253724 | KY | N | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | 253724 | KY | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | 253724 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 255960 | 01 | KY | LCSW | OTHER |