Basic Information
| Provider Information | |||||||||
| NPI: | 1952362162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESTILL | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 RUSTIC DR | ||||||||
| Address2: | |||||||||
| City: | MILLERSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446541413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306740576 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 710 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COSHOCTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 438121615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404549766 | ||||||||
| FaxNumber: | 7405886452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 06/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I9557 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 307822 | 01 | OH | TRICARE/MHN PIN | OTHER | 000000340446 | 01 | OH | ANTHEM PIN | OTHER | 543521000 | 01 | OH | MAGELLAN PIN | OTHER | 7594528 | 01 | OH | AETNA PIN | OTHER | 5773 | 01 | OH | FEI BH PIN | OTHER | Y543521 | 01 | OH | THE HEALTH PLAN PIN | OTHER |