1144565607 NPI number — MS. LYDIA ANNE KASMOCH MA, LPC

Table of content: MS. LYDIA ANNE KASMOCH MA, LPC (NPI 1144565607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144565607 NPI number — MS. LYDIA ANNE KASMOCH MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASMOCH
Provider First Name:
LYDIA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KASMOCH
Provider Other First Name:
LYDIA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144565607
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 N. CAMPBELL ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-999-9540
Provider Business Mailing Address Fax Number:
915-247-2025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 N. CAMPBELL ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-999-9540
Provider Business Practice Location Address Fax Number:
915-247-2025
Provider Enumeration Date:
12/10/2012

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: 101YM0800X , with the licence number:  71946 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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