Provider Demographics
NPI:1396838355
Name:INNES, LYNDA DIANE (LMHC, LPC)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:DIANE
Last Name:INNES
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 N GEORGIA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-3435
Mailing Address - Country:US
Mailing Address - Phone:641-422-0070
Mailing Address - Fax:641-422-0060
Practice Address - Street 1:22 N GEORGIA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3435
Practice Address - Country:US
Practice Address - Phone:641-422-0070
Practice Address - Fax:641-422-0060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00252101YM0800X
NC4851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102576Medicaid