1922181817 NPI number — MS. LYNDA BARRETT HARGROVES LCSW

Table of content: MS. LYNDA BARRETT HARGROVES LCSW (NPI 1922181817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922181817 NPI number — MS. LYNDA BARRETT HARGROVES LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARGROVES
Provider First Name:
LYNDA
Provider Middle Name:
BARRETT
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1922181817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 114
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37621-0114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-952-4666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4132 BRISTOL HWY
Provider Second Line Business Practice Location Address:
PARKSIDE CENTER SUITE 3
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-2932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-952-4666
Provider Business Practice Location Address Fax Number:
276-794-7965
Provider Enumeration Date:
10/23/2006

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:  LSW0000003529 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LSW0000003529 . This is a "LCSW LICENSE NO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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