Provider Demographics
NPI:1083346647
Name:COSTELLO, LINDSEY MARY FAYE (MS)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:MARY FAYE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3752
Mailing Address - Country:US
Mailing Address - Phone:636-368-7939
Mailing Address - Fax:
Practice Address - Street 1:1636 PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-3752
Practice Address - Country:US
Practice Address - Phone:636-368-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KS04274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health