Provider Demographics
NPI:1245381698
Name:EAVES, LONNY WAYNE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LONNY
Middle Name:WAYNE
Last Name:EAVES
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50605
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0605
Mailing Address - Country:US
Mailing Address - Phone:806-353-4630
Mailing Address - Fax:806-353-0430
Practice Address - Street 1:1901 MACKENZIE TRL
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-3730
Practice Address - Country:US
Practice Address - Phone:806-353-4630
Practice Address - Fax:806-353-0430
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional