Individual
JACK ESTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1418 MORNINGSIDE DR. NE, ALBUQUERQUE, NM 87190
(505) 255-4191
Mailing address
PO BOX 30103, ALBUQUERQUE, NM 87190-0103
(505) 255-4191
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPCC3280
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44922779
—
NM
Enumeration date
04/04/2007
Last updated
02/23/2010
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