Provider Demographics
NPI:1881938785
Name:ESTIS, THOMAS CLIFTON (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CLIFTON
Last Name:ESTIS
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 1:1106 STUBBS AVENUE SUITE B
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211
Mailing Address - Country:US
Mailing Address - Phone:318-237-5741
Mailing Address - Fax:318-816-5332
Practice Address - Street 1:1106 STUBBS AVENUE SUITE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71211
Practice Address - Country:US
Practice Address - Phone:318-237-5741
Practice Address - Fax:318-816-5332
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA758101YA0400X
LA1870101YM0800X
LA107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist