Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Rehabilitation, Substance Use Disorder |
261QR0405X | |||
Clinical |
1041C0700X | 80 | Licensed Clinical Social Worker | |
Community Health Worker |
172V00000X | |||
Counselor |
101Y00000X | |||
Nurse Practitioner |
363L00000X | 50 | Nurse Practitioner | |
Psychiatry |
2084P0800X | 26 | Physician/Psychiatry |
| NPI Number | 1770088130 |
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| LBN Legal business name | S48WY4, LLC | ||||
| Authorized official | LYNN THOMPSON - (PRESIDENT) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | Yes | ||||
| Enumeration date | 03/28/2018 | ||||
| Last updated | 09/12/2019 - About 7 years ago | ||||
| Identifiers |
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