Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 20042177A | IN |
Y | 103TC0700X | Clinical Psychologist | 20042177A | IN |
NPI | 1013130871 |
---|---|
Provider Name | Dr. Bradley Wayne Estes |
First Address | Hope, IN 47246-9623 |
Second Address | Columbus, IN 47203-3391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 06/10/2015 |