Provider Demographics
NPI:1225483704
Name:LYNDI N FARNAM, LLC
Entity Type:Organization
Organization Name:LYNDI N FARNAM, LLC
Other - Org Name:LYNDI N FARNAM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FARNAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-565-0064
Mailing Address - Street 1:2109 N PATTERSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2577
Mailing Address - Country:US
Mailing Address - Phone:229-232-4833
Mailing Address - Fax:
Practice Address - Street 1:2109 N PATTERSON ST STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2577
Practice Address - Country:US
Practice Address - Phone:229-232-4833
Practice Address - Fax:877-343-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0052161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1013294966OtherBLUE CROSS BLUE SHIELD/ANTHEM