Provider Demographics
NPI:1760698518
Name:ESTES, ROBERT THEODORE (MS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:THEODORE
Last Name:ESTES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 QUAIL PL
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-2433
Mailing Address - Country:US
Mailing Address - Phone:417-388-2185
Mailing Address - Fax:
Practice Address - Street 1:1434 QUAIL PL
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2433
Practice Address - Country:US
Practice Address - Phone:417-388-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001804101YP2500X
MO300013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498261809Medicaid