Provider Demographics
NPI:1386836195
Name:GOLDSMITH, LYNNE (LMFT, LCPC, NCC, MA)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:LMFT, LCPC, NCC, MA
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 82045
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-2045
Mailing Address - Country:US
Mailing Address - Phone:775-200-0935
Mailing Address - Fax:775-440-1037
Practice Address - Street 1:1255 WATERLOO LN
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-7403
Practice Address - Country:US
Practice Address - Phone:775-200-0935
Practice Address - Fax:775-440-1037
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2020-10-21
Deactivation Date:2018-09-20
Deactivation Code:
Reactivation Date:2020-10-21
Provider Licenses
StateLicense IDTaxonomies
NVCP0026101YP2500X
NV01121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1386836195Medicaid