Provider Demographics
NPI:1063836138
Name:ESTES, VICKIE LYNN
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYNN
Last Name:ESTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W GARDENGATE WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0805
Mailing Address - Country:US
Mailing Address - Phone:775-443-1761
Mailing Address - Fax:
Practice Address - Street 1:301 W GARDENGATE WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0805
Practice Address - Country:US
Practice Address - Phone:775-443-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health