Provider Demographics
NPI:1164036943
Name:HARVEY, LYDIA MARIE
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 JACKALOPE ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1550
Mailing Address - Country:US
Mailing Address - Phone:615-962-0929
Mailing Address - Fax:
Practice Address - Street 1:1803 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2201
Practice Address - Country:US
Practice Address - Phone:193-124-7031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health