Provider Demographics
NPI:1346619822
Name:ESTES, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
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 1:2025 S WASHINGSTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0828
Mailing Address - Country:US
Mailing Address - Phone:517-371-1111
Mailing Address - Fax:517-371-1121
Practice Address - Street 1:2025 S WASHINGSTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0828
Practice Address - Country:US
Practice Address - Phone:517-371-1111
Practice Address - Fax:517-371-1121
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6401014138101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional