Provider Demographics
NPI:1376579953
Name:BURROUGH, LYNN PAXTON (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:PAXTON
Last Name:BURROUGH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 639
Mailing Address - Street 2:
Mailing Address - City:LAKE JUNALUSKA
Mailing Address - State:NC
Mailing Address - Zip Code:28745-0639
Mailing Address - Country:US
Mailing Address - Phone:828-627-8744
Mailing Address - Fax:828-627-8744
Practice Address - Street 1:563 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786
Practice Address - Country:US
Practice Address - Phone:828-627-8744
Practice Address - Fax:828-627-8744
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR015440 11041C0700X
NCC0063181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0004622005OtherAETNA
NYP982279OtherOXFORD HEALTH PLANS
NY6257216OtherUNITED HEALTH CARE
NY117686OtherTRICARE
NY91443000OtherMAGELLAN BEHAVIORAL HEALT
NY0062148003OtherGHI
NY0062148003OtherGHI
NY117686OtherTRICARE