Provider Demographics
NPI:1114503141
Name:PERCIVAL, LYNNE MARIE (LPC, LCDC, MS)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:PERCIVAL
Suffix:
Gender:F
Credentials:LPC, LCDC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 SPRINGHILL CT
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-0605
Mailing Address - Country:US
Mailing Address - Phone:817-739-4462
Mailing Address - Fax:
Practice Address - Street 1:412 SPRINGHILL CT
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-0605
Practice Address - Country:US
Practice Address - Phone:817-739-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13882101YA0400X
TX76118101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13882OtherLCDC
TX76118OtherLPC