1477522605 NPI number — MS. LYNNE A MOREE LPC

Table of content: MS. LYNNE A MOREE LPC (NPI 1477522605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477522605 NPI number — MS. LYNNE A MOREE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOREE
Provider First Name:
LYNNE
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477522605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1656
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH WILKESBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28659-1656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-838-1644
Provider Business Mailing Address Fax Number:
336-667-7720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 JEFFERSON ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
NORTH WILKESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28659-3543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-838-1644
Provider Business Practice Location Address Fax Number:
336-667-7720
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2408 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N/A . This is a "MHNET" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 12566 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 115710 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2054015 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: B0243 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: N/A . This is a "CAROLINA BEHAVIORAL HEALT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6102745 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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