Provider Demographics
NPI:1013130871
Name:ESTES, BRADLEY WAYNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:WAYNE
Last Name:ESTES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14740 N COUNTY ROAD 350 E
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:IN
Mailing Address - Zip Code:47246-9623
Mailing Address - Country:US
Mailing Address - Phone:812-764-0733
Mailing Address - Fax:888-366-7403
Practice Address - Street 1:2675 FOX POINTE DR A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3391
Practice Address - Country:US
Practice Address - Phone:812-376-0900
Practice Address - Fax:888-366-7403
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042177A103G00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1677Medicare PIN
VAQ37715AMedicare PIN
VAP00999266Medicare PIN