Provider Demographics
NPI:1851494561
Name:ESTES, MELISSA MICHELLE (MFT, LCPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MICHELLE
Last Name:ESTES
Suffix:
Gender:F
Credentials:MFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E RIVER DR STE 315
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5774
Mailing Address - Country:US
Mailing Address - Phone:309-733-7500
Mailing Address - Fax:
Practice Address - Street 1:1225 E RIVER DR STE 315
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5774
Practice Address - Country:US
Practice Address - Phone:309-733-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003020101YP2500X
IA00221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0283507Medicaid
IAI8118Medicare ID - Type Unspecified