Provider Demographics
NPI:1114173457
Name:DOLD, LYRIC LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LYRIC
Middle Name:LYNN
Last Name:DOLD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 BASKERVILLE WALK
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-1902
Mailing Address - Country:US
Mailing Address - Phone:608-217-5802
Mailing Address - Fax:
Practice Address - Street 1:330 S WHITNEY WAY
Practice Address - Street 2:SUITE 303
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4638
Practice Address - Country:US
Practice Address - Phone:608-217-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3268125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3268125OtherDEPARTMENT OF REGULATION AND LICENSING
WI43571300Medicaid