1821164518 NPI number — MS. LYDIA SAYRE LENNIHAN LPCC

Table of content: MS. LYDIA SAYRE LENNIHAN LPCC (NPI 1821164518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821164518 NPI number — MS. LYDIA SAYRE LENNIHAN LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENNIHAN
Provider First Name:
LYDIA
Provider Middle Name:
SAYRE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LENNIHAN
Provider Other First Name:
LYDIA
Provider Other Middle Name:
SAYRE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPCC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1821164518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 BRYN MAWR DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87106-2206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-242-3050
Provider Business Mailing Address Fax Number:
505-256-5171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 BUENA VISTA DR SE STE 313
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87106-4291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-681-0708
Provider Business Practice Location Address Fax Number:
505-256-5171
Provider Enumeration Date:
11/27/2006

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:  93501 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 65873874 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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