Provider Demographics
NPI:1346447422
Name:ESTES, JOE SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:SCOTT
Last Name:ESTES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 MORNINGSIDE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5640
Mailing Address - Country:US
Mailing Address - Phone:505-264-9607
Mailing Address - Fax:
Practice Address - Street 1:427 SEMINOLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3747
Practice Address - Country:US
Practice Address - Phone:231-737-1213
Practice Address - Fax:231-737-1218
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013504103T00000X
NM661103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP23730005Medicare PIN